PA22 Teleconsultations for Eczema in CHildren (TECH) feasibility study: exploring patient and parent experiences and views of teleconsultations for paediatric eczema follow-up through qualitative interviews
Authors: Natalie King Stokes, Aoife Daly, Sarah McCusker, Manrup Hunjan, Ellen Vincent, Ashima Lowe, Carolyn Charman, Susannah George, Lea Solman, Jonathan Mathers, Esther Burden-Teh
Journal: British Journal of Dermatology (2024)

Abstract The COVID-19 pandemic sparked a digital transformation within the National Health Service (NHS), changing how we deliver care and accelerating the use of teleconsultations within paediatric dermatology (McCusker S, King Stokes N, Hunjan M et al. Paediatric dermatology teleconsultations: a survey of healthcare professionals in the UK. Clin Exp Dermatol 2023: 48: 785–9). Provision of teleconsultations remains a priority for outpatient service transformation and in achieving the NHS’s commitment to net zero carbon emissions by 2040. This qualitative interview study forms part of wider feasibility work to inform a potential trial comparing face-to-face appointments with teleconsultations for paediatric eczema follow-up. Parents and adolescents were recruited via an online survey advertised on social media. Objectives were to explore experiences, views and preferences of different appointment types and how teleconsultations could be optimized. Acceptability of teleconsultations and feasibility of a potential trial were explored. Ten semistructured interviews were conducted with eight parents and two adolescent–parent dyads on Microsoft Teams. Interviews were transcribed verbatim. NVivo software (QSR International, Doncaster, Australia) was used to manage the coding of interview data, which were analysed thematically using framework analysis. Three researchers developed the coding, with supervision from a qualitative researcher. Participants had direct experience of telephone and video consultations and included parents of children and adolescents aged 3–16 years. Themes included what is important in an eczema consultation and the value of a dermatology appointment. Parents highlighted the responsibility and isolation felt managing eczema and its impact on their lives. Long waiting times and limitations accessing paediatric dermatology placed greater value on appointments and impacted how parents felt about teleconsultations. Further themes included concerns about patient assessment, the complexity of acceptability, patient choice, and optimizing teleconsultations. Concerns were raised regarding the lack of child involvement in teleconsultations and limitations of examination through photographs and video. Whether patients found teleconsultations acceptable was a complex entity, with many finding them acceptable under certain conditions, such as when the skin was stable or they felt confident managing it. Teleconsultations were deemed unacceptable when the skin was flaring and examination was needed. Parents would like more choice in how their child is followed up. Many felt that teleconsultations were useful as an adjunct to face-to-face appointments, perhaps as part of a hybrid model of follow-up. These emerging findings, along with data from patient and clinician surveys, will inform an intervention for inclusion in a future trial. This intervention should reflect a future outpatient model, encompassing a mix of face-to-face and remote appointments, accommodating patient and clinician preferences, while also being deliverable within NHS resources.