Discussion
The COVID-19 pandemic presents an opportunity to explore new ways to
care for patients. Across the NHS, clinicians have had to adapt to
reduced capacity, infection control and social distancing measures.
Increasingly, virtual clinics are being introduced in secondary care.
Studies have shown that diagnosis of peripheral vestibular pathology
e.g. BPPV, made by telephone interview, compares favourably with
diagnoses made by neuro-otologists in face-to-face clinics(6). Our study
investigated whether telephone consultations for patients with dizziness
had different outcomes when a diagnostic questionnaire was used. The
findings suggest the questionnaire helped clinicians make a diagnosis,
reduced the need for additional investigations and reduced telephone
follow-up.
A number of questionnaires have been used in the management of dizziness
such as the dizziness handicap inventory (DHI)(7) and the University of
California, Los Angeles Dizziness Questionnaire (UCLA-DQ)(8). The
results described above comprise the first report to specifically
investigate the usefulness of a questionnaire in telephone consultations
. These results show that using the Roland dizziness questionnaire (RDQ)
as an adjunct to telephone consultations reduced the need for patients
to come into hospital for face-to-face consultations and reduced the
number of investigations ordered and reduced the number of telephone
follow-up appointments. The initial telephone consultation freed up ENT
outpatient capacity for face-to-face consultations for conditions that
need visual assessment, such as hoarseness or suspected cholesteatoma.
Our findings do not suggest that the questionnaire changes the rate of
requests for further face-to-face ENT assessments. This may be because
conditions such as Benign Paroxysmal Positional Vertigo (BPPV) require
face-to-face diagnosis and treatment (Dix-Hallpike and Epley manoeuvres
respectively) or perhaps patients with hearing loss struggle with
telephone consultations. In the future treatments for conditions such as
BPPV could potentially be delivered by tele-medicine e.g. by developing
devices such as a cell phone balance trainer(9).
Other studies have described the patient perceptions of telemedicine in
ENT practice during the COVID-19 pandemic(10). We did not include a
formal assessment of patient perception and satisfaction with the
telephone consultation in our study. But we did ask both patients and
clinicians about usefulness of the questionnaire. Telemedicine has been
adopted out of necessity during the COVID-19 pandemic, but 46% of
patients found the questionnaire useful, suggesting growing acceptance
of this ‘new normal’. In an even greater proportion of consultations
(69%), clinicians found the questionnaire helpful – showing the
usefulness of this questionnaire clinically.