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Working together to evaluate Virtual Transient Ischaemic Attack outpatient clinics

Transient Ischemic Attacks (TIAs) have symptoms similar to a stroke and are caused by a temporary disruption to the blood supply in the brain. For patients, they are a major health concern because they can indicate a higher chance of having a stroke in the future.

During the COVID-19 pandemic, offering face-to-face consultations and follow-up appointments for TIA patients was challenging. Virtual TIA outpatient clinics became a promising alternative.

Virtual clinics were rolled out rapidly, but there was little underlying research into how they can best be delivered for TIA patients at each stage of their illness.

There is some concern that models of care that rely on digital technologies, like virtual clinics, can be difficult for some patients to access and exacerbate existing health inequalities. This is particularly relevant to TIA and stroke since socio-demographics, like prevention, play a role in their prevalence.

While many services have since returned to face-to-face clinics, some continue to offer virtual clinics, or a hybrid approach.

Evaluating virtual TIA outpatient clinics

Funded by the NHS Insights Prioritisation Programme, this evaluation looked at the effectiveness, efficiency and experiences of virtual TIA clinics across NHS Trusts in the South East of England, in comparison to the face-to-face model of care. Led by Health Innovation Oxford and Thames Valley and the NIHR ARC Oxford and Thames Valley, the project relied on a rapid mobilisation of existing collaborations across Oxford Academic Health Partner organisations and NHS Trusts.

The findings from this evaluation offer critical insights into the potential of virtual clinics to enhance patient care, streamline healthcare delivery, and reduce costs. The insights can potentially inform guidelines and change clinical practice, bringing benefits to patients with TIA and those involved in their care.

What the project did

Over an 18-month period, the multidisciplinary team of academics, two public partners with lived experience of TIA, clinicians and health innovation specialists undertook a comprehensive evaluation of TIA outpatient services across Trusts in the South East region. It covered four areas:

  • Describing the views and experiences of patients and healthcare professionals: Through interviews, the project team gathered insights from both patients and healthcare professionals to understand their experiences with virtual clinics versus face-to-face consultations. This information provided a detailed understanding of the benefits and challenges associated with each approach.
  • Pathway mapping: The project team mapped the patient journey from initial referral by a GP to follow-up or referral to other services. This allowed for a systematic comparison of the pathways for virtual and face-to-face clinics, identifying potential areas for improvement.
  • Environmental sustainability: The environmental impact of virtual clinics was compared to face-to-face clinics, considering factors like travel to and from the clinic.
  • Resource use: The project looked at the type of healthcare professionals involved in care, the time taken at each stage of the pathway, and the cost-effectiveness of this model of care.

Who could benefit?

The significance of this project extends to health commissioners, those working in TIA services and their patients across participating NHS Trusts and the wider NHS. It is also relevant to Integrated Stroke Delivery Networks (ISDNs). The evaluation provides a better understanding of patient experience and need, which means services can be designed with the flexibility to adapt to patient preference and to offer a choice of face-to-face or virtual consultations.

Implementing virtual models of care where appropriate can optimise how resources across the healthcare system are allocated and streamline services. The evaluation demonstrates the potential ways in which the use of virtual models in NHS TIA services could improve cost-effectiveness and efficiency.

Outputs from the evaluation will also help inform future clinical practice and training for healthcare professionals, enabling them to provide care which better meets the different needs of patients.

Collaboration and engagement

As a jointly-led project between Health Innovation Oxford and Thames Valley and the NIHR ARC Oxford and Thames Valley, the project’s success was rooted in collaboration and engagement across a wide range of stakeholders These include Patient and Public Involvement (PPI) members, the University of Oxford, five Integrated Stroke Delivery Networks across the South East of England and their respective NHS organisations. The collaborative nature of the project facilitated interdisciplinary approaches, allowing each partner to equally contribute their expertise.

Clinical teams from various TIA services across the South East played a crucial role in the project by providing access to patients and actively participating in the evaluation process. This collaboration helped bridge the gap between research and practical implementation, meaning that the project’s findings can be applied more effectively in clinical settings.

“The transformation of health and care relies not just on centres for high-quality research, but also the availability of skilled facilitators and practitioners for implementation who work across different organisations, so new innovations can be appropriately adopted and spread into practice. This is the first project of its kind where the ARCs and the Health Innovation Networks have been given the space and funding to evaluate new ways of delivering healthcare. We relied heavily on the local infrastructure we have in place for collaborative working across the academic and health partners, and were able to access senior buy-in as and when we needed it. This meant the project was completed very rapidly. New partnerships have since formed for future projects.”

Sarah Brown, Senior Implementation, Innovation and Evaluation Manager, NIHR ARC Oxford and Thames Valley.

Next steps

Following the publication of their evaluation report, the team are working to develop a framework to support how TIA services are designed and delivered. This framework will apply to TIA services nationwide and will aim to improve patient care and resource allocation.

The success of this project demonstrates the value of collaboration between healthcare organisations, academic institutions, and patient representatives. Future initiatives in the region could build on this model of collaboration to address other healthcare challenges.