Remote care - good for some, but not for all?

The COVID-19 pandemic fuelled an unprecedented expansion in remote health service delivery globally and employers and governments encouraged people to stay at home to reduce the spread of the virus. In many countries, including the United Kingdom (UK), primary and secondary health care shifted rapidly to ‘remote by default’, with a substantial increase in the use of virtual care such as home monitoring and home based treatment, supported by telephone and online methods to interact with patients and care service users. Remote care has long been advocated, not least by companies that market digital technologies. The promise is convenience and choice: features that many people enjoy in other areas of everyday life, with many government, financial and consumer services moving to digital first, or digital only modalities. As we move from the pandemic, remote care delivery in the UK is becoming a ‘new normal’: the number of telephone appointments in general practice rose from 3.5 million in 2019 to 11.4 million in March 2021. Remote home monitoring or virtual (COVID) wards proliferated during the pandemic, despite a rapid systematic review in 2021 being unable to reach substantive conclusions regarding efficiency, safety or the identification of early deterioration for patients with COVID-19. In the USA, remote patient monitoring increased more than fourfold during the pandemic and the UK has set the ambitious aim to have introduced 40–50 ‘virtual ward beds’ per 100,000 population by December 2023. There is also growing research interest in other forms of remote care such as telephone and online triage and video consulting.