Lloyds Online Doctor Ireland Patient Survey 2014
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Lloyds Online Doctor Ireland Patient Survey 2014

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Lloyds Online Doctor Ireland launched on the 8th of July 2013 and has 15,000 registered patients as of April 2014. ...

Lloyds Online Doctor Ireland launched on the 8th of July 2013 and has 15,000 registered patients as of April 2014.
Contraception is our most popular area of treatment, representing 76% of all consultations. This is followed by erectile dysfunction (17%) and STI testing (5%). Our patient profile mirrors this trend – over half of all our patients are female and between the ages of 25-35.

How does Lloyds Online Doctor work?

Patients log in to lloydsonlinedoctor.ie and complete a clinical questionnaire relating to their chosen treatment area. The questionnaires are dynamic and substantial – our contraception questionnaire alone has over 30 fields. Once complete, a clinically designed algorithm categorises patients by risk. For instance, a patient with a BMI over 30 and who is also a smoker will have these details flagged on their record. Once categorised, the patient data is sent to our doctors who decide whether it is suitable to issue a prescription. Often they will contact patients for further information – this is done via an online patient record or via telephone. Over time the patient record becomes a useful source of data, building a holistic picture of each patient’s situation.

About this survey

The purpose of this survey is to assess our performance against a number of key indicators, including our ability to communicate effectively and the quality of care that we provide. We asked eighteen questions, based on those asked by the NHS. The survey was sent out to 13,524 registered patients on the 14th of March 2014. This sample includes the 8% of patients who have been refused treatment on clinical grounds. As of the 7th of April we have
received 894 completed surveys, a response rate of over 6%.

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Lloyds Online Doctor Ireland Patient Survey 2014 Lloyds Online Doctor Ireland Patient Survey 2014 Presentation Transcript

  • Irish Clinical Satisfaction Survey April 2014 From left: Dr Christina Hennessey, Dr Tatjana Street, Stephen Bourke, Dr Tom Brett and Dr Gigi Taguri
  • Irish Clinical Satisfaction Survey 2 Medical Director’s Introduction The term ‘online doctor’ still carries a lot of baggage in Ireland and patients are right to be sceptical. It’s an alien concept that suffers from a negative association with spam email, illegal online pharmacies and irresponsible medicine. However, done right, we believe that technology can have a transformative effect on healthcare, improving access, choice and affordability. But how do we define best practice? In the UK, the Care Quality Commission (CQC) regulates our practice to ensure that we meet their rigorous standards for the provision of primary care. In Northern Ireland the Regulation & Quality Improvement Authority conducts a similar audit. We embrace this approach as it helps patients to distinguish between legal and illegal practices, promoting safety. Regular audits provide us with critical feedback to ensure that we are providing the best possible service to patients. Progressive legislation enables us to innovate and find new ways to use technology to solve healthcare problems. In the Republic of Ireland there is currently no equivalent to the CQC and the Medical Council of Ireland’s guidelines for telemedicine are limited. This makes it difficult for Irish patients to know who to trust and stifles healthcare innovation. In order to address this gap we have developed our own patient satisfaction survey, based on the guidelines provided by the NHS. We are very pleased at the overall response rate and feedback. The survey has also highlighted areas where we need to improve, something that we take very seriously. On behalf of myself and the rest of the doctors I want to thank our Irish patients for their support over the past year and welcome the opportunity to work with Irish regulators to define best practice. Dr Tom Brett Medical Director LloydsOnlineDoctor “I just wanted to email you to thank you and to say that I think this is the best idea that I’ve come across in a long time. I have suffered with erectile dysfunction for ten years and embarrassment has prevented me from seeking any sort of help from my own GP. I have now received my prescription with a range of possible treatments today so at last I can at least have a chance to restart my sex life. For that I am truly grateful.” Feedback from a male patient, published with permission
  • Irish Clinical Satisfaction Survey 3 General Manager’s Report Lloyds Online Doctor Ireland launched on the 8th of July 2013 and has 15,000 registered patients as of April 2014. Contraception is our most popular area of treatment, representing 76% of all consultations. This is followed by erectile dysfunction (17%) and STI testing (5%). Our patient profile mirrors this trend – over half of all our patients are female and between the ages of 25-35. We believe that demand is driven by convenience as much as affordability – while our consultations are typically cheaper than face to face consultations, 38% of our patients have a Medical Card or GP Card. This means that despite qualifying for free or subsidised primary care a large minority of patients are willing to pay a fee for the convenience and discretion of an online service. How does Lloyds Online Doctor work? Patients log in to lloydsonlinedoctor.ie and complete a clinical questionnaire relating to their chosen treatment area. The questionnaires are dynamic and substantial – our contraception questionnaire alone has over 30 fields. Once complete, a clinically designed algorithm categorises patients by risk. For instance, a patient with a BMI over 30 and who is also a smoker will have these details flagged on their record. Once categorised, the patient data is sent to our doctors who decide whether it is suitable to issue a prescription. Often they will contact patients for further information – this is done via an online patient record or via telephone. Over time the patient record becomes a useful source of data, building a holistic picture of each patient’s situation. What is to stop patients lying? Nothing. We believe that patients should take responsibility for their own health, whether online or in a face to face consultation. However, our algorithm enables us to flag inconsistencies which our clinical team can then decide to challenge. Ultimately the decision to prescribe is up to our doctors, not the algorithm. A credit card is also required for payment, which helps prevent identity fraud. LloydsOnlineDoctor About this survey The purpose of this survey is to assess our performance against a number of key indicators, including our ability to communicate effectively and the quality of care that we provide. We asked eighteen questions, based on those asked by the NHS. The survey was sent out to 13,524 registered patients on the 14th of March 2014. This sample includes the 8% of patients who have been refused treatment on clinical grounds. As of the 7th of April we have received 894 completed surveys, a response rate of over 6%. Summary of results We are pleased with these results, particularly given that we only launched nine months ago. Better still are the 159 practical pieces of feedback that we have received from patients. We have bunched these into themes on page seven and will work to improve each area over the coming year. Crucially, we need to improve the way we communicate with pharmacists and with the 8% of patients that our doctors cannot treat on clinical grounds. We also need to sort out logistical challenges, such as how we can get time sensitive prescriptions to patients faster. Transparency and data protection The information that we collect from our patients is privileged and survey data is no different. However, anonymised patient data may be made available to accredited Irish healthcare professionals for non-commercial purposes and in accordance with EU data protection laws. Interested parties should contact us at info@lloydsonlinedoctor.ie for more information. Stephen Bourke General Manager OVERALL Max score: 5 CARE Max score: 5 COMMUNICATIONS Max score: 5 RESPECT Max score: 100%
  • Irish Clinical Satisfaction Survey 4LloydsOnlineDoctor Excellent Good Average Poor Very Poor 0 10% 20% 30% 40% 50% 60% I don't want to talk about my treatment with my GP I don't currently have a regular GP Lloyds Online Doctor is cheaper than seeing my GP Lloyds Online Doctor is more convenient than seeing my GP I was unable to get to an appointment with my GP Why did you decide to use Lloyds Online Doctor? (Please tick all that apply) n=850 How would you rate the quality of care that you received when using our service? Very happy Quite happy Neither happy nor unhappy Not happy How happy are you with the overall service provided by Lloyds? Average score: 4.63 out of 5 n=850 Average score: 3.71 out of 4 n=850 Overall Service
  • No Yes No Yes No Yes Very easy Quite easy Quite difficult Very difficult Irish Clinical Satisfaction Survey 5LloydsOnlineDoctor How easy did you find it to get the information you needed about your treatment and the medication prescribed by our doctors? Were you aware that our doctors sent you information about your treatment after you ordered (via your patient record)? Average score: 3.64 out of 4 n=838 Did you feel confident enough to ask the doctor a question through your patient record if you had any concerns or questions about your treatment? If you messaged our doctors via your patient record were their questions and responses clear and understandable? Yes: 66.7% n=838 Yes: 90% n=320 Yes: 93% n=210 Communication
  • Don't know No Yes Don't know No Yes Don't know No Yes Irish Clinical Satisfaction Survey 6LloydsOnlineDoctor Overall, how would you rate the communications you have received from Lloyds Online Doctor? Did you feel your privacy was respected when using Lloyds Online Doctor? Average score: 4.59 out of 5 n=827 Did you feel that you were treated with respect when using Lloyds Online Doctor? Are you confident that your data is being held and managed securely by Lloyds Online Doctor? Yes: 91.2% n=748 Yes: 94.5% n=785 Yes: 76.9% n=817 Excellent Good Average Poor Very poor Respect
  • Irish Clinical Satisfaction Survey 7LloydsOnlineDoctor Areas for Improvement 1. Communication with pharmacists What our patients say: “[I experienced] raised eyebrows and questions from the pharmacist followed by a backroom consultation among staff when I presented the prescription!” Some pharmacists have queried the validity of scripts issued by our doctors, particularly with regards to our English practice address. We will address this issue by launching a communication campaign in the pharmacy trade press. 2. Delivery options and timings What our patients say: “I placed my order for my prescription on the third of March. Was told it would have arrived within five days. I am still waiting.” As electronic prescriptions are not currently legal in Ireland we have to send out our prescriptions by post. Sometimes scripts get lost – in this instance we issue a second script and send it via registered post at no additional charge. We will investigate courier options and how we can work with a patient’s nominated pharmacy in order to find a more reliable solution. 3. Communication when treatment is refused on clinical grounds What our patients say: “I was refused weight loss medication, which I ac- cept, but I was not given a reason why.” Our doctors may find that it is not medically appropriate to provide a prescription for treatment – this occurs on average 8% of the time. We are currently reviewing our patient messages to ensure that we provide clearer reasons when treatment is refused. 4. Providing holistic healthcare solutions What our patients say: “Getting my blood pressure is a bit of a nuisance... but I can understand why you need it. If there was some way of making that easier it would be good.” We will investigate ways in which we can work with other healthcare providers (such as chemists, medical device suppliers and nurses) to improve access. 5. Linking payments to existing healthcare infrastructure What our patients say: “I got no receipt provided, so I am unable to get a partial refund through my insurance.” We will work with insurers to understand if our consultations can be covered by traditional plans and provide patients with itemised receipts in the first instance. Please note that receipts are available on request. 6. Improving our patient record What our patients say: “The doctor needed additional information but I did not realise they would be contacting me through the Lloyds portal rather than email or text.” Data protection restrictions mean that we cannot communicate personal information via email or text. However, we are currently upgrading our content management system which will improve visibility of messages. We will also look to simplify the messages going out, in order to make clinical communication as clear and concise as possible. We asked patients “What can we do to improve our service?”
  • Emily and Bobby, the stars of our STI testing campaign. See the video at bit.ly/1jnznBD For more information please contact Rebecca Matthews at info@lloydsonlinedoctor.ie Lloyds Online Doctor 50-54 Wigmore Street London W1U 2AU