The Effective Management of Idiopathic Intracranial Hypertension Delivered by In-person and Virtual Group Consultations: Results and Reflections from a Phase One Service Delivery

ABSTRACT

The increasing incidence of idiopathic intracranial hypertension (IIH) with the obesity epidemic is leading to increased pressures on service capacity. Evidence shows that group consultations (GCs) deliver effective, person-centred healthcare, but the feasibility for IIH is unknown. We set out to develop and test a safe and effective GC service for IIH. Through an interactive approach, we co-designed a bespoke in-person and virtual GC model, where patients are reviewed in a group setting. Improvements were made following each session following patient input and team reflections. Outcomes measured included patient satisfaction, self-perceived health literacy, and successful implementation of the GCs. During the pilot, eight in-person GCs were delivered: once-monthly (Oct–Dec 2019), then twice-monthly (Jan–Feb 2020). Feedback was received from 49/53 patients. 100% felt more satisfied and heard, 100% felt more involved in decision-making, 98% had a better understanding of their condition, 96% felt more able to cope with their condition and keep themselves healthy, 94% rated this as a positive experience, and 90% reported improved access and more time with their clinician compared with existing 1:1 appointments. Since September 2020, in response to the COVID-19 pandemic, we transitioned to weekly virtual GCs, receiving overwhelmingly positive feedback (median scores: patient satisfaction 9.5/10; being listened to by clinician 10/10; involved by clinician in treatment decisions 10/10; clinician explanation of treatment 10/10; and opportunity to discuss condition or treatment 10/10). GCs are safe and effective for IIH, and preferred in our patient cohort. This allowed ongoing high-quality, person-centred care despite challenges from the COVID-19 pandemic.

KEYWORDS:

• Group Consultations
• idiopathic intracranial hypertension

Acknowledgments

This work could only be possible with the generosity and support of many amazing hardworking colleagues from the Eye Dept (including Shamim Miah, Ulla Lyttners; Maureen Bagnall; Robert Goldstone; Matt Robertson; Salvatore Savarese; Karen Kim Evans-Davis; Isabelle Chow; Parul Patel; Mariya Stoycheva, Pallavee, Aurora, Bianca and other ophthalmic technicians; Toni Brush; Elliot Cornish); the Orthoptic leads (Liz Tomlin, Karla Tocher) with the vision of developing extended-role/specialist neuro-orthoptists; GSTT management (including Nigel Davies; Leila Hosseini; Miles Stanford; Alice Jarvis; Kyle Reid). Thanks also to Sir Jules Thorn Charitable Trust for subsidising the cost of training from Group Consultations Ltd; The Group Consultations Ltd team for training and support; The British Society of Lifestyle Medicine & Dr Fraser Birrell for the GC session at the 2019 conference which inspired this work, and for the 2020 top abstract award; HSJ for shortlisting this and the follow-on GC work for the 2021 Acute Sector Innovation Award; this work has been long-listed for the Royal College of Physicians Excellence in Patient Care Awards 2021.

Declaration of interest statement

Alison Manson is the UK Training and Implementation Lead for Group Consultations Ltd, a not-for-profit organisation that supports training and implementation of group consultations in GP practices and NHS organisations across the UK. The other authors have no declarations.

Supplementary material

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Additional information

Funding

The GSTT IIH team’s training by Group Consultations Ltd, was funded by the Eye Dept, and part-subsidised by the Sir Jules Thorn Charitable Trust.