The importance of “being seen”: a qualitative interview study of patient and clinician experiences of virtual and face-to-face TIA clinics in one region of England

Abstract Background Most NHS trusts introduced virtual clinics for managing transient ischaemic attack (TIA) during the Covid-19 pandemic. Some continue to use virtual clinics, whilst others returned to face-to-face or implemented hybrid clinics. There has been limited evaluation of the effectiveness and experience of patients and healthcare professionals (HP) of virtual TIA clinics. Methods A rapid insights evaluation of the effectiveness of virtual TIA clinics took place in South East England. This paper focuses on findings from one part of the evaluation, which conducted qualitative interviews with 15 patients and 12 HPs across 6 NHS trusts to explore their views and experiences of different TIA clinic care models. Patient participants were identified by clinicians at first consultation with the TIA clinic. Telephone or video interviews were recorded and analysed using thematic analysis. Results HPs reported that virtual clinics worked well for some patients (e.g., those not needing MRI/MRA imaging, older patients with co-morbidities/poor mobility, young working people, people living in rural areas) but not all. Most patients placed great importance on ‘being seen’ by a HP in a face-to-face consultation during their TIA care pathway. We identified two key themes which represent different yet complementary dimensions of the importance of ‘being seen’, highlighting the perceived value of face-to-face consultations over virtual TIA clinics: (1) Greater opportunities for communication; and (2) Feeling looked after and listened to by a multidisciplinary team. Conclusions Virtual TIA clinics were perceived more positively by HPs than patients, who particularly valued face-to-face consultations. Yet HPs also identified distinct benefits of face-to-face consultations. Whilst further research is needed, our findings indicate that TIA service model design should consider how HPs interact with patients during assessment and diagnosis. A hybrid model of TIA clinic care may offer the greatest potential benefits to patients and clinicians. Offering choice of TIA clinic modality could be a priority, along with improved referral that reflects which patients are best suited to virtual or face-to-face care.