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Vol 24, No. 05, May 2020For e-subscribers (PDF)
Guide Developed for Remote Consultation for Suspected COVID-19 Patients
A team of researchers form the Nanyang Technological University, Singapore (NTU), National University of Singapore (NUS) and University of Oxford formulated a guide for primary healthcare workers for conducting remote consultations.

Face-to-face consultations and examinations of patients has been restricted in many countries as many are required to self-isolate or quarantine themselves due to the COVID-19 pandemic. Inevitably the use of digitalization would apply for healthcare, leading to an increase demand for telemedicine.

The team comprising of Associate Professor Josip Car at NTU, Professor Trisha Greenhalgh from University of Oxford and Professor Gerald Koh at NUS have collaborated to develop a guide to help doctors adapt to the need for more remote assessments.

The work has since been published in peer-reviewed medical journal The BMJ in March 2020. The UK-based National Institute for Health and Care Excellence (NICE) has incorporated the guidelines on COVID-19 to manage suspected or confirmed pneumonia in adults in the community.

NICE provides authoritative guidance for appropriate treatment and care of patients within the National Health Service in England and Wales. Its resources are widely referred to by clinicians around the world, including Singapore.

Amid the COVID-19 pandemic the guide is expected to be a helpful tool for primary care health workers to embrace telemedicine.

Assoc Prof Car who is with NTU's Lee Kong Chian School of Medicine said, "We can expect to see an increasing shift from in-person consultation to telemedicine in the future. It is therefore important for clinicians to have clarity on good practice and our guideline addresses the urgent need by providing a broad orientation to a COVID-19 consultation, including safety net advice for patients."

In Singapore, the use of telemedicine is encouraged by the government to promote safe distancing and to reduce the risk of transmission of the novel coronavirus.

Trisha Greenhalgh, who is Professor of Primary Care Health Sciences at Oxford University, said, "We've long known that telemedicine can help doctors save money and time. Yet face-to-face consultations have remained standard operating procedure and the 'go-to' option. Now, COVID-19 has dramatically altered the risk-benefit balance in video versus face-to-face consultations. Suddenly, doctors need to become confident at consulting patients via video. Our work offers evidence-based advice from an international team which we hope can provide some clarity for those in the primary care service."

The guide lays out a template for doctors to use while conducting a consultation remotely. Some points to note in particular would be engaging to patient to speak in full sentences and also to observe the general demeanour of a patient to identify any red flags for COVID-19.

The guide was written based on a mix of COVID-19 published and unpublished research findings - the majority of which are from China and from the World Health Organization (WHO) guidance.

The team also conducted a poll of 50 medical professionals from countries including United Kingdom and Singapore, and leveraged findings from earlier related literature.

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