Dr James Galloway [pictured below], rheumatology consultant at King’s College Hospital NHS Foundation Trust and senior clinical lecturer at King’s College London, describes how using e-IMPARTS has helped inform patient needs during remote consultations.
IMPARTS (Integrating Mental & Physical healthcare: Research, Training & Services) has been developed to improve the support available for patients experiencing psychological distress, such as anxiety, low mood or depression, while receiving treatment for a physical health condition.
Part of the IMPARTS programme involves patients answering questions about their emotional wellbeing, including feelings of depression and anxiety. Patients complete questionnaires either on an iPad in a clinic waiting room, or since June 2020, through a link they receive via text message ahead of their appointment.
We caught up with Dr James Galloway to hear about his experiences using e-IMPARTS and the noticeable difference it has made in improving patient outcomes.
Please describe your role at King’s Health Partners
I’m a rheumatology consultant at King’s College Hospital NHS Foundation Trust and a senior clinical lecturer at King’s College London, so I do a split post between clinical medicine in Denmark Hill and research in the Centre for Rheumatic Diseases.
Tell us about your experience using e-IMPARTS in your clinic
I’ve always seen the value in using IMPARTS. The answers patients reveal in their questions give you a real sense of their health. I’ve used IMPARTS for nearly a decade now, in the form of patients completing questionnaires on tablets in clinic waiting rooms. During the pandemic, it’s been a huge advantage to be able to continue to use IMPARTS by moving over to the e-IMPARTS system. This allows patients to complete the questionnaires remotely, via a weblink, up to 24 hours before their consultation with us, in a location that suits them, like their home.
This makes e-IMPARTS especially useful in remote patient consultations. If I notice a patient hasn’t completed the questionnaire before an appointment, I can remind them to complete it by signposting the link in a reminder text message.
In your view, what are the benefits of using e-IMPARTS?
The value of patient reported outcomes, made available through IMPARTS and patients reporting how they are feeling through iPads in clinics, has always been tremendous. You could say its value has increased dramatically over this past year. Understandably, due to lockdown measures and keeping patients safe from COVID-19, we’ve relied more and more on remote patient consultations, such as talking to patients over the phone about their health, rather than them coming into clinics for face-to-face appointments.
When you’re not discussing someone’s health needs face-to-face, you’re missing out on vital nonverbal communication. For example, when you look at someone’s mental health, the emotive cues you normally get from talking with someone in a room, you can lose over the phone. That’s why learning about patient reported outcomes, made possible through e-IMPARTS, becomes a much more powerful tool. e-IMPARTS gives you the bigger picture of how a patient is feeling or how urgently they need attention for their mental and physical health.
How does e-IMPARTS give you a fuller picture of a patient’s mental or physical health?
e-IMPARTS is a very powerful way of being able to not only understand someone’s disease better, but also identify when their symptoms require additional support.
For example, if I’m talking with a relatively new patient over the phone, their e-IMPARTS score gives me a key indicator of how they are doing mentally and physically. When I ask how they’re feeling, there’s a chance they could be playing down their symptoms and say that they’re fine. However, their physical symptom scores could be disproportionately low, giving me valuable insight into whether I need to ask them to come into clinic for an urgent face-to-face consultation or refer them to other services for support.
How was the process of setting up e-IMPARTS in your clinic?
I’ve been trained on IMPARTS in the past. When e-IMPARTS went live during the pandemic, it felt like a very straightforward thing to do. When it went live it was seamless, and it worked as soon as it was switched on.
How has e-IMPARTS helped patients in your clinic?
The patient response has been brilliant. It’s a clear, easy to use and simple system. It’s great for patients as they are now given more time to complete the questionnaires, and I think the opportunity to complete it at home changes the dynamic of the conversation much more. You can be a lot more open and honest when the scores are brought up during a consultation, versus completing a questionnaire in a clinic waiting room. e-IMPARTS also gives you more time as a clinician to look at the patient’s question results, and to raise relevant topics in the consultation with a patient.
Have you any advice for those who may be interested in setting up e-IMPARTS in their clinic?
I would universally encourage it. The ‘no health without mental health’ concept is fundamental and it’s especially important if you’re not seeing patients in person. If you’re doing remote consultations and you can’t see someone’s face, the non-verbal cues are gone, and so to pick up on mental health comorbidity is much harder over the telephone.
Sometimes with patient consultations now, we’re phoning people at work, and the ability for them to talk openly is not always there. With e-IMPARTS, the ability to interact with the questionnaire somewhere in private, you can get a really good sense of patients’ health.
There’s plenty of support in place for patients you identify as at risk based on the patients’ e-IMPARTS results. If you discover one of your patients has mental health comorbidity, based on their e-IMPARTS score, there are very clear processes in place to support patients, and the support structures are there for us to respond to as clinicians.
This World Mental Health Day, what advice would you give to colleagues to better integrate mental and physical healthcare?
One thing that’s very striking is that in current times and during the pandemic, there has been substantially higher reported frequency of depression and anxiety in our community.
It’s not surprising that the current circumstances might result in low mood, but it’s really important to not to push it under the carpet. Certainly, for our patients and colleagues, it’s vital to recognise our mental health needs alongside our physical ones and support one another.