Teleconsultations for Eczema in CHildren (TECH) feasibility study: a mixed-methods study with adolescents and parents

Background: Teleconsultations form a key component of the National Health Service’s Long Term Plan, outpatient recovery and ­transformation, and commitment to net zero. There is currently little evidence to inform their delivery within paediatric dermatology, a specialty that is increasingly difficult to access. Teleconsultations may offer convenience and widen access for patients, particularly for follow-up of chronic conditions such as eczema.

Objectives: To explore patients’ and parents’ experiences and perceptions of teleconsultations for follow-up of eczema in secondary or tertiary care; to identify components of acceptability of different consultation types and explore how teleconsultations could be optimized; and to obtain views of a potential trial comparing face-to-face appointments with teleconsultations for paediatric eczema follow-up.

Methods: A mixed-methods study comprising an online survey and qualitative interviews with patients and parents of children with eczema, who had experience of teleconsultations under secondary or tertiary care, was carried out. An online survey was completed by eligible adolescents and parents. The results informed subsequent semi-structured interviews, conducted with patients and parents, and responses were analysed thematically using framework analysis.

Results: Survey responses from 31 parents and 20 adolescents were analysed. Overall, 41% were ‘satisfied or very satisfied’ following telephone appointments vs. 71% for video and 40% for online or mobile messaging. Preferred consultation type was face-to-face in 67%, with 31% preferring a combination of face-to-face and teleconsultations. Some 41% of participants were interested in participating in a trial comparing face-to-face and teleconsultations for eczema follow-up. Qualitative interviews were conducted with 10 parents and 2 adolescents. Six overarching themes were constructed from the interview data: the value of a dermatology appointment, what is important in an eczema consultation, concerns about patient assessment, complexity of acceptability, patient choice and optimizing teleconsultations.

Conclusions: While there was a preference for face-to-face consultations, teleconsultations were acceptable in certain situations, such as for stable eczema or to avoid missing school. Patient perspectives of how teleconsultations could be improved include sending photographs before the appointment and clinician training. This study suggests that directly comparing face-to-face appointments with teleconsultations in a future trial is unlikely to be feasible. A hybrid intervention combining face-to-face and teleconsultation would be more acceptable to patients and parents.