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.