Are online GP appointments the future of healthcare? Experts debate lessons taught by pandemic

E-Salud, Cambio de Modelo Sanitario y Covid-19 ('E-Health: Change in Healthcare Approaches and Covid-19') organised in part by the Merck Health Foundation started from the premise, cited by its CEO Carmen González Madrid (top left in the photograph) that the pandemic has led to a sharp rise in use of technology between patients and doctors and that this could be taken advantage of and developed further.

Tools including Artificial Intelligence, Big Data, video-conferences, telephone-based assistance and 'online medicine' were examined from a bio-ethical, legal and patients' viewpoint.

Head of Healthcare Legal Advisors Fernando Abellán (top row, second from left, in the photograph) said: “There are reasons to believe that the processes and pace of 'digital health' are set to speed up.

“The risk of contagion is going to be around for a long while and will extend the need to use technology to reduce the presence of patients in hospitals and surgeries.”

A 'Five Ps' approach, proposed by medical director of Madrid's San Carlos Clinical University Hospital Julio Mayol (top row, second in from right in the photograph), could be the starting point: Prediction, prevention, personalisation, population-wide, and participative.

“With this crisis, during it and before it, our priorities include changing leadership methods and cultures – we need to seek leadership that transforms, in all fields of society, and offer a vision of the future,” Dr Mayol says.

“We need to reinforce the idea of health against disease; what we've seen is that when public health is affected en masse, the health service becomes overwhelmed – a crisis in providing medical services, and a crisis that's present throughout the health-sickness cycle among society.”

Geriatrician Dr Salomé Martín (top right), head of technical development at Eulen Social Health, stresses that the elderly population's ability to adapt to new technology is underestimated.

“We all thought the elderly were not going to be capable of using a tablet or a mobile phone, and during the pandemic they've learnt how to, and this has allowed them to communicate with their families,” she says.

“People living alone have been able to get social and mental health support. The old-age gap still exists, but it's not insurmountable.”

In fact, technology companies worldwide specialising in 'tablets for the elderly' are experiencing success – 'everyday' language, large icons and simple functions, such as 'call [son/daughter]', 'watch news', and so on, have proven to be easy enough for even those with dementia to figure out.

This type of technology could be introduced to care homes, some of the worst-hit establishments during the pandemic, Dr Martín says.

“We have lots of care homes in very large buildings, with very long hallways, double bedrooms – all unsuitable for providing proper care during a pandemic,” she warns.

“Residential homes were outside the system and were forgotten about. We need to change our approach and structures.”

Medical director and head of innovation for new services and Sanitas hospitals, Dr Domingo Marzal (bottom row, left), says GP appointments 'are already on mobile phones' and the use of these during the Covid-19 crisis soared within his company: Throughout the whole of 2019, only 42,000 video-based consultations took place, but in 2020, over 65,000 were held in the month of April alone.

“The pandemic has been the proof of the pudding,” says Dr Marzal.

“It was a baptism by fire to see if the digital strategy we were aiming for was going to work or not.

“And e-health turned out to be very important when it came to the rise in mental health emergencies.”

Processes, ITC and systems manager at Quirónsalud private hospitals network, Dr Ángel Blanco Rubio (bottom row, centre), believes 'digitalisation' is what is now bringing about 'the biggest change ever in medicine', and that the 'great change' within this is that medicine is becoming 'more patient-centred'.

“We need to switch from a doctor-patient relationship to a patient-doctor relationship,” he said.

“The humanistic [patient-centred and patient-empowering] approach to medicine is not at all incompatible with the use of technology.

“In fact, the pandemic has done more for the digital transformation than any company, institution, politician, doctor or hospital manager has done: It's moved the whole thing forward in just two months.

“Many healthcare organisations have gone from zero to 75% online consultations just during the weeks of the virus.”

Dr María Gálvez (bottom right), managing director of the Plataforma de Organizaciones de Pacientes ('Association of Patients' Organisations', or POP) says 'even the most basic technology' – that of making telephone calls to patients – has 'offered reassurance, avoided possible contagion and face-to-face consultations'.

“For those with chronic conditions, medicine via technology encourages patients to keep appointments and continue treatment, and allows us to move forward in terms of tailoring medicine to the individual,” she says.

“Right now, with the Covid-19 situation, patients with chronic conditions are facing two-fold fears: That of catching the virus and their existing condition worsening, and that of not being seen to quickly enough for their conditions to be monitored and treated accordingly.

“They're afraid of delays in diagnoses which could worsen their survival rate or quality of life, and afraid of not being able to access the care they need; using technology could help allay these fears.”