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We read with interest the RNOH report regarding rapid implementation of virtual clinics due to Covid-19 (Gilbert et al, BMJ Open, 21 May 2020). The Royal Free Child and Adolescent Eating Disorder Service (RF-EDS) has similarly been required to adapt the service rapidly during the Covid-19 crisis, such that 95% of our patients have been treated by telephone or videoconferencing.
The clinical needs of our patients to receive evidence-based treatment, needed to be balanced with the risks of Covid infection. Eating disorders have the highest mortality of all psychiatric disorders and early treatment has been shown to improve outcomes. Treatment is usually outpatient care with a minority requiring short hospital admissions for medical stabilisation. The RF-EDS has a day service, which has managed higher risk patients in the community as paediatric wards in North Central London have closed/relocated during the pandemic.
Since the pandemic, all routine treatment to current patients has been via video or telephone, with high-risk patients continuing face-to-face care (socially distanced or with PPE). This can be stepped-up to prevent hospital admission. Meal support, a weekly parent support group and drop-in clinic have been set up to run via videoconference.
From 23/03/20 to 01/05/20, the number of new referrals to the service was similar to the same period in 2019 (19). The number of outpatient contacts was 731 and 96% of these were treated in virtual cli...
From 23/03/20 to 01/05/20, the number of new referrals to the service was similar to the same period in 2019 (19). The number of outpatient contacts was 731 and 96% of these were treated in virtual clinics. There were 697 patient contacts during the same period in 2019. The day service provided a total of 338 patient contacts, 48% via remote working.
There has been positive feedback from families who have welcomed the flexibility of remote treatment and the reduced need to travel. Some young people have reported that they are happier not to sit in a waiting room with other patients and take time out from education. Clinicians have found home working has improved efficiency. Daily team videoconferencing has maintained multi-disciplinary working with team meetings and supervision continuing remotely. There has been an increase in collaborative work with other community mental health teams through videoconferencing.
The main challenges have been developing rapport with new patients via videoconferencing and to gather information from non-verbal cues or family interactions, particularly when family members are required to face the camera. Engagement is a key aspect of treatment and there are concerns that safeguarding risks may be missed. Individual sessions can be hindered by lack of privacy and reluctance to be open about difficulties. Young people who are struggling with their appearance dislike seeing themselves on camera and it has been difficult for patients who prefer non-verbal aids to express themselves. Risk assessment of patients with serious mental health symptoms has not been considered safe enough to do remotely. In addition, there have been on-going challenges with the video platforms used.
Our view is that virtual clinics have so far been effective in providing routine treatments and have improved efficiency. Going forward, we would collaborate with service-users to decide how much treatment should continue virtually.