LAUSR

BACKGROUND The Covid-19 pandemic has led to changes in health service utilization patterns and a rapid rise in care being delivered remotely. There has been little published research examining patients' experiences of accessing remote consultations since Covid-19. Such research is important as remote methods for delivering some care may be maintained in the future. OBJECTIVE To use content from Twitter to understand discourse around health and care delivery in the UK as a result of Covid-19, in particular Twitter users' views on and attitudes to care being delivered remotely. METHODS Tweets posted from the UK between January 2018 and October 2020 were extracted using the Twitter API. 1,408 tweets across three search terms were extracted into Excel. 161 tweets were removed following de-duplication, and 610 were identified as irrelevant to the research question. Relevant tweets (n=637) were coded into categories using NVivo software, and assigned a positive, neutral, or negative sentiment. To examine views of remote care over time, the coded data was imported back into Excel so that each tweet was associated with both a theme(s) and sentiment. RESULTS The volume of tweets on remote care delivery increased markedly following the Covid-19 outbreak. Five main themes were identified in the tweets: access to remote care (n=267), quality of remote care (n=130), anticipation of remote care (n=39), online booking and asynchronous communication (n=85) and publicising changes to services or care delivery (n=160). Mixed public attitudes and experiences to the changes in service delivery were found. The proportion of positive tweets regarding access to, and quality of, remote care was higher in the immediate period following the Covid-19 outbreak (March-May 2020) when compared to the time before the Covid-19 onset, and the time when restrictions from the first lockdown eased (June-October 2020). CONCLUSIONS Using Twitter data to address our research questions proved beneficial for providing rapid access to Twitter users' attitudes to remote care delivery at a time when it would have been difficult to conduct primary research due to Covid-19. It allowed us to examine the discourse on remote care over a relatively long period and explore shifting attitudes of Twitter users at a time of rapid changes in care delivery. The mixed attitudes towards remote care highlights the importance that patients have a choice over the type of consultation that best suits their needs, and that the increased use of technology for delivering care does not become a barrier for some. The finding that overall sentiment about remote care was more positive in the early stages of the pandemic but since declined emphasises the need for a continued examination of people's preference, particularly if remote appointments are likely to remain central to healthcare delivery. CLINICALTRIAL