Post Publication Independent Review of
"Near telemedicine in general practice during the COVID-19 pandemic"
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Post Publication Independent Review of "Near telemedicine in general practice during the COVID-19 pandemic"
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Post Publication Independent Review of
Near telemedicine in general practice during the COVID-19 pandemic
Sohaib R. Rufai, NIHR Doctoral Fellow ST4 in Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust
Tania A. Rufai, GPST2, Medway NHS Foundation Trust, Medway NHS Foundation Trust
23 March 2020
British Journal of General Practice
1. Quote "General practitioners (GPs) may be at particular risk of contracting COVID-19 when seeing patients in the primary care setting, due to face-to-face consultations often in confined spaces.4 Longer exposure time likely increases risk of transmission.5 The Royal College of General Practitioners (RCPG) has suggested video or telephone consultations where possible,6 but these are not feasible when physical examination is required." End of Quote.
The authors are addressing a priority need of the hour, in attempting to protect General Practitioners (GPs) from human-human transmissions of COVID-19 during patient examination. This may extend to other health service professionals who come into close contact with symptomatic patients and asymptomatic carriers.
2. Quote "We propose the following near telemedicine protocol for GPs – a modified version of that recently proposed by Gunasekera for ophthalmologists7" End of Quote.
The authors are proposing a modified version of the near telemedicine protocol for General/Nurse Practitioners when examining symptomatic patients and asymptomatic carriers.
The steps are outlined as follows:
2a. Quote "A telephone or video triage with a GP or nurse practitioner can determine whether physical examination is required.
2b. If required, the patient is given an appointment to attend the surgery.
2c. The patient enters Room 1 with a freestanding tablet on a video call with the GP, who is sitting in Room 2 separately. 2d. The GP explains they will perform the majority of the consultation over the tablet and only enter Room 1 to perform physical examination, during which talking is only allowed at the discretion of the GP.
2e. After taking the history, the GP dons personal protective equipment (PPE), enters Room 1 to perform physical examination, then exits the room.
2f. The GP finishes the video consultation from Room 2 and, where required, leaves a prescription outside Room 1 for the patient to collect on departure."
End of Quote.
3. Quote "This protocol could substantially cut down the face-to-face component of GP consultations, thereby limiting exposure time. This could also be implemented across a range of specialties wherever there is a division in time between consultation and physical examination. We acknowledge that not all providers may have the required room space and equipment to implement this protocol. However, wherever possible, we hope this protocol could limit the transmission of COVID-19 and help protect healthcare professionals and patients." End of Quote.
The authors provide an insight regarding the effect of the modified version of the near telemedicine protocol for General/Nurse Practitioners in substantially limiting the exposure time with relevance to human-human transmission of COVID-19.
Since the infrastructure/establishment suggested by the authors may not involve a heavy expenditure, but at the same time reduce/limit the exposure of the General/Nurse Practitioners to COVID-19, the authors' suggestion of modified version of the near telemedicine protocol for General/Nurse Practitioners may be implemented at National Level so that the General/Nurse Practitioners may not succumb to the disease, due to which the entire National Level containment and treatment processes of COVID-19 could even be stressed out.