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The COVID–19 pandemic has created unprecedented opportunities for us to change the way we deliver healthcare to our patients. In the final feature of this Clinical Update series, we are honoured to have Mr Nicholas Teo Shao Wei from KK Women’s and Children’s Hospital (KKH) to share his experience with Dermatology video consultations as part of his work.

KKH Dermatology Pharmacists (left to right): Chen Mee Kuan, Goh Sok Hwei, and Nicholas Teo
(Disclaimer: photo was taken prior to social distancing measures during COVID-19 pandemic)

  1. Why is video consultation necessary in your area of practice?

    In our pharmacist-led eczema clinic, my colleagues and I serve paediatric patients, from infants to adolescents. In our population, a physical trip to the hospital may be a cumbersome task as caregivers would have to bring along diapers, hot water, expressed breast milk, pram, etc. Our video consultation service was started back in 2017 to increase accessibility of our consults. Having a digital platform allows caregivers to engage our services in the convenience of their own homes or even workplaces. This obviates the need for a trip to the hospital and their time can be redirected to caring for their children. As people started staying home during the COVID – 19 Pandemic, this service became even more essential.

    Studies have shown that patients with eczema are more compliant to treatment when they are followed up more frequently as it reduces any anxiety and concern accompanying the initial diagnosis. Typically, each patient would have an average of two to three follow-ups over a period of two to three months. Video consultation allows us to monitor our patients’ progress more frequently and address their concerns in a timely manner. Overall, this increases compliance and brings about an improvement in clinical outcomes.

  2. Can you describe how video consultation is conducted in your area of practice?

    In KKH, following in-person pharmacist-led individualised counselling for paediatric patients newly diagnosed with mild to moderate eczema, trained dermatology pharmacists conduct follow-up sessions to ensure continuity of care. Utilisation of video conferencing enables the trained pharmacists to assess patients' current skin conditions objectively and provide timely recommendations on the skincare management. In conjunction with a collaborative prescribing agreement with the dermatologists, our pharmacists provide optimisation and/or resupply of medications to these patients. For those with well-controlled eczema and whose caregivers are confident of continuing with self-management, the pharmacists can discharge them to primary care physicians with an open-dated dermatologist appointment.    

  3. For video consultation to take place, were there eligibility criteria for the patients to meet?

    Any paediatric patient with mild-to-moderate eczema who is referred and have attended the specialised dermatology counselling by our pharmacists is eligible for this video consultation service.

    The caregiver and patient must commit to being present during the video consultation.

  4. Did you face any challenges with the process of video consultation?

    Caregivers were less receptive to video consultation when we first started this service four years ago. Back then, video conferencing was not as widely utilised. However, due to the COVID-19 pandemic, most people have embraced video conferencing in many aspects of their lives. Because of this increased familiarity with video conferencing and “work from home” arrangements, caregivers are now keener and more available to sign up for this service.

    Good video resolution is important to accurately assess patients’ skin condition. Generally, we have a clearer view when caregivers use the back camera of their phones and when patients stand in a place that is well lit. However, in cases where video resolution remains poor, we will advise the caregivers to send us photos of the identified skin areas via email. Usually, such photos will be clear enough for us to make an objective assessment.

  5. Follow up question: Any tips to increase acceptance rates and to prepare patients for video consultation?

    We will explain the purpose of our service to the caregivers so that they understand and appreciate the value that we can add to the care of their children. After which, parents become more committed to future video consultations.

    It also helps that we send them a SMS reminder a few days prior to the video consultation. We will include the link to the video consultation in the SMS, thus allowing for a fuss-free and seamless access to the Zoom session.

    Most of the caregivers are tech-savvy, and have experience using Zoom, thus we hardly face any problems with scheduling and setting up the video consultation.   

  6. Were there measures put in place to ensure protection of patient’s confidentiality during video consultation?

    We use Zoom - the official video conferencing tool in SingHealth. This platform is secure as there is no option for cloud storage. The caregivers will be required to enter a unique PIN to access the session, thus mitigating the threat of “Zoombombing”, where an uninvited or unauthorised person joins our Zoom meeting. As an added measure against unintended “visitors”, we will also lock the virtual room after admitting the patient.

    To further ensure confidentiality, we will assure parents that there will be no video recording or photographing of the session, and that our pharmacists will conduct the session in a private consultation room.

  7. What training was provided for practitioners before embarking on video consultation and was it adequate?

    We were trained by our dermatologists through a series of lectures on the common skin conditions in the paediatric population. We also had to clock 150 hours of clinic attachment to ensure competency in our practice.

    Subsequently, our prescribing and discharge practices are guided by a collaborative prescribing agreement, which is reviewed biannually.

  8. Have there been any interesting encounters so far?

    There was a patient who had her video consultation slot in the afternoon, immediately after school. As she could not make it home in time, she and her mother had to join the video consultation while they were travelling on the public transport. As I had to see the patient’s skin condition, her mother was taking videos of her as she turned back and forth on the public transport. Thankfully, there were not many commuters around. This is a testament to the convenience of video consultation, whereby patients can get access to healthcare services anywhere they are.

  9. Has video consultation changed the way you communicate with other healthcare professionals?

    With video consultation, it is even more important that we document the session clearly to ensure proper continuity of care. If there are any pertinent changes to the condition or management of the patient, we will update the primary physician via a secured communication platform to ensure that these changes are communicated across.

  10. Beyond COVID-19, do you think video consultation will be here to stay?

    Yes, I believe that it will be an integral part of providing medical care in the future. We have seen an increase in uptake of our eczema follow-up video consultation service ever since the outbreak of COVID-19. Recently, we increased the number of weekly video consultation slots to meet the increasing patient load.