Remote care – putting the patient in charge

Cullington, Helen (2023) Remote care – putting the patient in charge. 14th Asia Pacific Symposium on Cochlear Implant and Related Sciences, Coex, Seoul, Korea, Republic of. 08 - 11 Nov 2023.

Record type: Conference or Workshop Item (Paper)

Abstract

People with cochlear implants need lifelong care to achieve their best outcomes. The COVID-19 pandemic facilitated a widespread rapid introduction of remote care in most healthcare settings. Technology also improved considerably e.g., online consultations and groups, Zoom, Teams, and enhanced autocaptioning. Some cochlear implant companies introduced new tools to facilitate caring for patients remotely. Almost all aspects of cochlear implant care for adults and children can now be done remotely: tuning, rehabilitation and lifelong care (not the surgery … yet!). Many cochlear implant centres now offer a blended service: some appointments are in person and some are offered remotely. Cochlear implant companies now also offer apps to allow the patient to manage their own care at home, for example adjusting programs, finding a lost processor, testing hearing and speech perception, checking equipment, and uploading photos of the implant site. However some aspects of care can be missed when done remotely, for example equipment issues, extra headpiece magnets added, wellbeing or safeguarding concerns, non verbal cues, or cochlear implant microphone issues (if testing is done using streaming).

Sometimes the people who need remote care the most cannot access it, for example a patient with mobility issues, living alone many hours from the implant centre … with no computer or smartphone. In the United Kingdom (UK), around a third of the public feel that increased use of technology made sense during COVID-19, but was ‘not for the long term’ [1], with barriers including digital skills, connectivity, accessibility, confidence and motivation. Some sectors of the population are more likely to be digitally excluded than others, for example people who are older, in lower income groups, without a job, in social housing, homeless, those with disabilities, people with fewer educational qualifications, people living in rural areas, and those whose first language is not English. More than 11 million people lack basic digital skills to use the internet effectively in the UK [2].

Just because it is technically possible to do something remotely does not mean it is the right thing for the patient. We need to always put the patient in charge of their care, and use shared decision making between the patient and their family and clinician to decide what is the best option. We need to codesign, implement and evaluate care with patients for patients – ensuring we continue to provide high quality, sustainable, accessible, flexible cochlear implant services. We need to explore patient preferences for how they receive their care, and ensure they are empowered to make the right decision for them at that time.

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