Remote-by-Default Care in the COVID-19 Pandemic

Study Overview
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Brief Summary
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18 month study, funded by ESRC COVID-19 research fund. The aim is to explore and support the rapid shift from face-to-face to remote (telephone and video) conversations in primary care. There are three components: a study of clinical interactions and decision making (micro); four locality-based organisational case studies of new models of care (meso); abd a a study of how digital innovation can support NHS infrastructure and vice versa (macro).

Detailed Description
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18 month study, funded by ESRC COVID-19 research fund. The aim is to explore and support the rapid shift from face-to-face to remote (telephone and video) conversations in primary care. There are three components: a study of clinical interactions and decision making (micro); four locality-based organisational case studies of new models of care (meso); abd a a study of how digital innovation can support NHS infrastructure and vice versa (macro). The methods are mainly qualitative (interviews, virtual ethnography, analysis of documents, micro-analysis of conversations) and are designed to inform action research. Key deliverables: At least two evidence-based assessment tools: qualitative (questions for remote assessment of breathlessness) and quantitative (a COVID-19-specific early warning score) Transferable lessons about how to achieve rapid spread and scale-up, spread in real time through our extensive intersectoral networks Strengthened infrastructure for supporting digital innovation in the NHS

Official Title
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Remote-by-Default Care in the COVID-19 Pandemic: Addressing the Micro-, Meso-, and Macro-level Challenges of a Radical New Service Model

Conditions
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COVID-19

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inclusion criteria for interviews Willing and able to give informed consent for participation Aged 18 years or above Staff involved in delivering remote-by-default services in the frontline or 'back offices' Patients/carers who have crossed paths with primary care services during the Covid pandemic. Pharmacy case studies: Staff involved in delivering remote pharmacist consultation services in the frontline or 'back offices' Patients/carers who have crossed paths with community pharmacy primary care services during the COVID-19 pandemic. Inclusion criteria for video and telephone consultations Patients who have remote primary care consultation regarding symptoms associated with COVID-19 and their clinicians (based in Oxford/Thames Valley) who have agreed to participate in the study Inclusion criteria for focus groups Patients that have experienced self-reported 'long Covid' symptoms (for patient only focus groups) Clinicians that have experienced self-reported 'long Covid' symptoms (for clinician only focus groups) Exclusion Criteria: Patients or clinicians who are too ill to be interviewed -

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Remote assessment tools<br>Qualitative methods: semi-structured interviews for approx 40 front line clinical practitioners | |
| RECAP early warning score<br>Development of disease specific early warning score, building on earlier work through literature review and NEWS2 score | |
| Implementation/Scale up case studies<br>Study of implementation and scale up of remote-by-default at four different UK sites | |
| Infrastructure strengthening<br>Theory and data driven change effort involving policymakers, regulators, professional bodies, industry, patients and citizens with a view to overcoming interacting issues impacting success of digital projects. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Remote COVID-19 Assessment in Primary Care (RECAP) Early warning score | A set of questions and a predictive tool built into electronic records, designed to distinguish people with suspected covid-19 who need to go to hospital from those who can safely be monitored at home. The final Remote COVID-19 Assessment in Primary Care (RECAP) Early warning score score divides people into 'green' (stay at home, self-monitor), amber (professional monitoring e.g., via virtual wards with home oximetry), or red (assess in person promptly). | 18 months |