Why Ongoing Follow-Up Care Matters in Telehealth Treatment

The initial consultation is typically the main event in the design of a service delivered by telehealth. This is where identity is verified, history is taken and a decision is made about treatment of a clinical nature. However the quality of service is usually determined in the weeks and months following the initial consultation when the practitioner can no longer simply call for the patient to return to a clinic.

Follow-up is a data collection problem before it is a care problem

A clinician reviewing a patient’s case 3 months after treatment commencement needs more than their recollection of events between reviews. This is especially true at 12 weeks when many variables, including dose, frequency of symptoms and adherence, are subject to the practitioner’s imperfect recall.

Decide on the 3-4 variables that will change the clinical decision for the majority of patients on a particular treatment pathway before the first review. Use a validated outcome measure, an adverse effect list, an adherence measure and a marker of functional change. Collect everything else and it will probably go unread.

Making asynchronous capture clinically meaningful

Short regular check-ins can be very effective between appointments but it must be someone’s responsibility to read and act upon them. If patients understand that their input will not be used then completing a questionnaire between appointments will fall out of favour very quickly. Provide for an escalation process and define within this what actions will result from certain defined answers (e.g. Worsening score on an outcome measure or report of an adverse event) within a set time frame.

Side effects are under-reported unless you ask directly

Normalisation of side effects by the patient or their carer occurs particularly when they perceive benefit from treatment, or fear that withdrawal of the treatment may occur. Patients generally expect that health professionals will seek information about problems, therefore ‘open’ questions (which imply no particular problem exists) about adverse events or problems are generally met with a negative response.

In addition, the practitioner needs to know what the patient has done in the time between appointments. As mentioned previously, self-management decisions such as changing a dose, ceasing or reducing a treatment, adding other treatments or medications and interactions with new medicines from other practitioners are all divulged in follow-up reviews. Often these are the most important parts of the follow-up review.

Reviewing whether treatment remains appropriate

Suitability for treatment is not decided at initiation of service, i.e. A patient who was suited to treatment at start of service may no longer be suited after change in diagnosis, when pregnant, on new medication, or other changes including change in occupational requirements to drive for example or become safety-critical for work.

For review appointments, having a clear decision point (i.e. Do not automatically renew for another period of time) such as to continue on same dose, to increase / decrease in defined steps, to refer for a face-to-face assessment and to stop with a tapering off regime and recording the reasons for this decision to progress the patient’s history.

Choosing a review cadence 

These timeframes should be seen as a starting point only. A reduction in review periods will be appropriate for patients with a high risk of relapse, significant comorbidity, or those being treated with certain types of medication or for specific treatments.

Keeping the practitioner relationship intact across distance

When continuity of practitioner cannot be guaranteed through rostering, it must be reconstructed by means of a handover note, written by the practitioner who conducted the review, that contains the clinical impression of the review as well as the data that was recorded. Clinics setting up this kind of system are well served by looking at how an established provider structures telehealth follow-up care before designing their own review workflow.

Correspondence with other healthcare providers (e.g. Treating clinicians or patients’ General Practitioners) after each substantive review with patient consent is also required to avoid duplication and potential interactions.

Practical measures that improve attendance

•     Book the next review before the current appointment ends, rather than relying on later recall
•     Send reminders at intervals that suit the cohort, with a simple rescheduling path
•     Flag non-attendance as a clinical event requiring follow-up, not an administrative gap
•     Offer a short asynchronous option for stable patients who struggle with scheduled calls
•     Record the reason for any patient-initiated discontinuation

What to audit

1. Proportion of patients attending their first scheduled review
2. Median time from adverse event report to clinician contact
3. Rate of treatment cessation or change at review, which indicates whether reviews are genuine decision points
4. Continuity rate, measured as patients seen by the same practitioner across consecutive reviews
5. Correspondence rate to the patient’s usual general practitioner

These figures are uncomfortable to view at first but also serve as a crystal clear indicator of whether or not you are providing ongoing care to your patients as part of your service or simply making an initial decision and sending them on their way.