Clinical Guidelines

Healthcare Professionals Guidelines

These indications are for the use of the Abi ProApp for contributing healthcare professionals. They provide guidelines to answer all kinds of  questions from Abi’s customers. 

To create these guidelines, we have used information from scientific articles, as well as our experience from hundreds of thousands of cases handled by Abi’s healthcare Professionals and monitored by Abi’s medical team. 

What is Abi?


Abi Global Health is a company registered in Ireland that provides health services available to users all over the world. Our objective is to be their first source of health services, using mobile technology in the most convenient way. 

Abi is the name of the chat interface that receives questions from patients, sends them to the Healthcare Professionals (HCPs) and then sends the healthcare professionals’ answers back to the patients. Technically, Abi is an artificially intelligent agent, or Chatbot, that uses natural language processing technology to turn normal human language into computer commands to operate the service and provide the answer from the physician to the user.

Healthcare Professionals (HCPs) in Abi can be physicians, nurses, physiotherapists or psychologists. When the healthcare professionals receive a question, the patients can see the name of the healthcare professional answering their question. Patients can also see a profile of every healthcare professional with some essential information. This helps us build trust in that the healthcare professional will answer their questions. 

From the patient’s viewpoint, they can ask questions either via a chat app (Whatsapp, Telegram, Viber, etc.) or from a website. There are 5 different types of services provided by Abi: micro-consultations, video-consultations, voice-consultations, mental health and prescriptions. First, the patient must choose the type of consultation they want, and after that they are able to send the inquiry. 

It is important to keep in mind that not all patients have access to all services provided by Abi (e.g. not all patients can receive prescriptions or can do video-consultations). Therefore, you must be careful, and not refer patients to other services inside Abi.

General rules for all kinds of consultations

Professionalism

• Make the care of the patient your first concern: keep your knowledge and skills up to date, be honest and act with integrity.
• Work within the limits of your competence.
• Treat each patient as an individual: take into account their history and cultural values.
• Refer a patient to another practitioner/ face-to-face consultation when necessary.

Safety 

• If the patient presents a serious condition that must be evaluated in a face-to-face consultation, refer them to seek medical attention.
• Respect the patient’s confidentiality at all times.

• You must pay attention to all the information given by the patient and respond honestly to all of their questions and concerns.
• You must give patients the information they want or need in a way they can understand.
• Your answer must be formal, clear and adapted to the level of knowledge of the patient. Avoid using complex medical terminology and make sure that the patient has understood what you have said.
• Be polite and considerate and respect the dignity and privacy of every patient.
• Be empathetic, so that you can build a trusting relationship with the patient.
• You must support patients in caring for themselves to empower them to improve and maintain their health.
• You must not express your personal beliefs (including political, religious or moral beliefs) to patients.

Text-Consultations


A text consultation consists in a text-based consultation where the patients can ask their questions via a chat app or website. They can add attachments (e.g pictures or test results) to the message and ask follow-up questions.

Patients regularly ask for medical advice (treatments, referrals), guidance and information. It is your job to answer respectfully and give the appropriate information so they are adequately informed by a real healthcare professional.

You have no commitment to answer the questions and you can always decline or exit the case and leave it for another healthcare professional if you see you can’t answer appropriately.

Remember that a text-consultation is not a substitute for a face-to-face consultation, your objective is to guide and inform the patient. Therefore, whenever you think a physical exploration is needed or that there may be an emergency, refer the patient to a hospital or give them the tools to get in touch with an emergency service.

Description of the Process

In case of follow-up questions

The patients have the possibility to ask a new question after the first answer. The first healthcare professional to be notified is the same one who provided the previous answer. If after 3 minutes the follow-up question has not yet been claimed, other healthcare professionals will be notified. 

In case of follow up questions, it will always be possible to see the entire case from the first question, including the answers provided by other healthcare professionals.

Keep in mind that the patients can ask a limited number of follow-up questions when asking questions to the patients. Try to be specific and ask questions back only if necessary.



General considerations

• Greeting patients: Always greet the patient and warmly express that you are available to answer their questions. A best practice is to begin with sentences like "I'm sorry to hear you're not well" or "Thanks for your question".
• Give informative answers: Your answers are expected to be informative and to help the users with the concerns they have about their health. Remember that you can’t make a prescription from a text micro-consultation.  
• Acknowledge the limitations: Always explain that the opinion is given according to the information available. 
• Do not assume the identity of the user: In general, the user will remain anonymous, and their questions can be answered by other healthcare professionals, so whenever facing a consultation do not jump to conclusions about the identity of the user.
• Medical Common Sense: Provide information that is in accordance with the information provided by the user. Abi’s health services are intended to be a useful tool for users who have health concerns and need reliable information to help them make decisions.
• Work within the limits of your competence: If you are not able to provide a pertinent answer, or you just don’t have the time, you can skip the question or cancel at any point during the process.
• Always be respectful: Make sure to be respectful to the inquirer but also to previous caregivers; be supportive of a pre-existing relationship.
• Digital Bedside Manner: Use a sober and gentle style for the answers. After hundreds of thousands of cases, we know our users, like most people, don’t like short and sharp answers, even if the user may sometimes provide information using a truncated ‘SMS-style’ of writing.
• Ending the answer: Finish sentences with comforting phrases such as, “I hope this reassures you” or “I hope you feel better”, which we have found our users greatly appreciate. 
  
  
  Strategies to answer medical text-based consultations

Some basic rules will help you to answer questions in a safe and helpful way:

• Keep close to the facts given in the inquiry.
• Answer in the clearest and simplest way possible. This doesn’t mean a short answer, it is important to clarify the answer with an explanation.
• Always try to give an explanation. Most of the time, even when the patients are looking for guidance or when you think they should go to a face-to-face consultation, the patient needs a little information of what might be happening to them.
• Explain medical terms in plain language. Personalise the answer to match the language used by the inquirer and to the perceived knowledge level of the inquirer.
• Avoid trying to diagnose; instead educate, guide and empower. Often the user only needs to know what the next step they should take is.
• If you need more information or clarify the inquiry, ask short and concrete questions to the inquirer.

Prescriptions

Description of the process

General considerations

• Read the patient’s information carefully: Pay attention to their age and weight and always read the key findings and the questionnaire to avoid toxicity/ interactions or other patient harm.
• Take into account the patient’s comment on the request: They may give you useful information about what is happening to them.
• Patient’s safety first: If you think it is not safe to prescribe the patient what they are asking for (because you consider that it can be harmful or because it is not appropriate), decline the request and explain the reasons why.
• Base your prescriptions on medical evidence and try to be up-to-date with the recommendations.
• Work within the limits of your competence: If you are not sure about a prescription, leave the request for another physician. 
• If you are unsure about interactions or other aspects of prescribing medicines, seek advice from experienced colleagues or look for the information from appropriate sources.
• Make sure your prescription orders are clear and easy to understand.
• If possible, try to give alternatives to the prescription and guidelines for the patient’s health, such as when to go to the hospital for a face-to-face visit.
  
  

Considerations for the issuing of prescriptions via text consultation

• Limited indications:
  

   

  The prescription service offered by Abi is limited to the list of indications shared to each HCP. The list is limited to what we consider safe to prescribe via a text consultation.

  If the user is requesting medication for an indication that is not listed, they must be redirected to an in-person consultation or video consultation.

  Do not tell the user they can get medication via the Abi prescription service for an indication that does not exist. 

• Multiple prescription requests:

   

  At times, it may be necessary to prescribe the user more than one medication for an indication. However, our system only permits the prescription of one medication at a time. 

  In such cases, it's acceptable to prescribe the first medication and include a note in the instructions advising the user to submit another request for any additional medications they require. 

  Do not refuse the initial prescription request solely to prompt users to make multiple additional prescription requests

• Controlled substances, antibiotics and antivirals:

   

  The prescription of controlled substances; i.e., opioids, benzodiazepines, and antidepressants are prohibited on our platform. If uncertain, decline the prescription request and flag the case.

  Prescribing oral antibiotics is restricted to specific indications. Please refrain from prescribing oral antibiotics for indications not listed.

  Under no circumstances should oral antivirals be prescribed. However, topical antivirals may be prescribed for the indication of cold sores.

Video Consultations

Description of the process

General considerations

• Introduce yourself: Remember that this is the first time you and the patient are meeting, so always be polite, introduce yourself, and greet the patient so you can build a trusting relationship.
• Patient comfort/ ability: The patient’s comfort level with telemedicine might vary, you need to act accordingly to their limitations and concerns.
• Conversation style and approach for understanding: Keep in mind that you do not have the full range of communication tools that you would have during a face-to-face conversation (body language, etc), so you have to make sure that the patient understands all the information you are trying to communicate. Consider slowing down your pace of speech and ensure that the patient has understood the information.
• Limitations: you might need to ask some extra questions in order to compensate for the loss of face-to-face contact (e.g. physical changes may be less apparent).
• Clear guidelines/ recommendations: be very clear in your communication of recommended care plan/ next steps so there are no misunderstandings.
• Write all take-home messages in the summary: make sure to write all the important information that the patient has to know in the report, such as problem recognition, possible diagnosis and recommendations/next steps (if needed).
• Refer all critical calls to emergency services: examples of critical calls include abdominal or chest pain, fever of unknown origin, high fever lasting more than 48h, convulsions, visual alterations and the onset of labor.

Environmental considerations

When answering a video consultation, it is important to ensure that the environment is adequate to make the patient feel comfortable talking about their concerns and so you can give the best medical advice. Some things to consider are:

• Privacy: You should be in a quiet, private location for the consultation. If this is not possible, use headphones to ensure others can’t hear the patient’s side of the conversation. Make sure that other people are not walking through the area.
• Background: Clear obstacles and distractions. It is best that the patient can see that you are in a professional setting and are alone for the visit.
• Clothing: Dress conservatively and respectfully, the same way you would for an in-office visit.
• Lighting: Be as well-lit as possible for improved eye contact and trust. 
• Camera placement: make sure that the patient can see your face and try to make eye contact with the camera, not the patient’s face. If you need to look away, let the patient know why. If you are answering the video consultation with your phone, try to place the phone on top of a solid and stable surface, so the image is not constantly moving.
• Background noise: Minimize background noise to reduce distractions (no music/ tv/ radio or other controllable noise). Let the patient know if background noise on their end is keeping you from fully focusing on their care and provide suggestions for complete focus. 
• Focus: Never multitask while answering a video-consultation. Don’t conduct a visit while driving or otherwise occupied.

Voice consultations

Description of the process

General considerations

• Greeting patients: Introduce yourself and warmly express to patients that you are happy to speak to them. This interaction will be the first impression that a patient has of you.
• Refer all critical calls to emergency services: Examples of critical calls include abdominal or chest pain, fever of unknown origin, high fever lasting more than 48 hours, convulsions, visual alterations and the onset of labour.
• Clear guidelines/ recommendations: Be very clear in your communication of recommended care plan/ next steps so there are no misunderstandings.
• Write all take-home messages in the summary: Make sure to write all the important information that the patient has to know in the report, such as problem recognition, possible diagnosis and recommendations/next steps, if needed.
• No distractions: Avoid distractions and multi-tasking while answering a telephone consultation.
• Privacy: Maintain the patient’s privacy when communicating over the phone talking from a quiet place that does not allow others to hear any audio.

Strategies to answer medical telephone consultations

• Obtain as much information as possible about the patient’s presenting complaint in a logical sequence as you would do in a face-to-face consultation: never forget to ask about medical history, current medications and allergies to help you arrive at an accurate appraisal of the patient’s condition.
• Ask open-ended questions to elicit sufficient data to assist with decision-making.
• Avoid jumping to conclusions regarding the patient’s situation.
• Listen carefully and allow the caller the time and opportunity to ask questions.
• Speak to patients clearly and slowly, and enunciate carefully. 
• Use easy-to-understand language that avoids medical terminology.

Mental Health consultations

Description of the process

General considerations

• Greeting the patient: Always start the answer by saying hello to the patient to build a relationship in which the patient feels confident and feels that the advice is being given by someone who wants the best for them.
• Explain the findings in the questionnaire to the patient: If the patient has filled a mental health questionnaire, explain to them what the answers might mean.
• Keep close to the facts given in the inquiry.
• Validate the patient’s feelings or symptoms: Express empathy and the understanding of the patient’s feelings and avoid blaming and judging.
• Always be respectful to the inquirer but also to previous caregivers; be supportive of a pre-existing relationship.
• Explain medical terms in plain language: Personalise the answer to match the language used by the inquirer and to the perceived knowledge level of the inquirer.
• Give different solutions or advice to the patient so they know they have options available to cope with their symptoms: Therapies or exercises, medication if needed, referral to a psychologist/ psychiatrist, etc.
• Avoid trying to diagnose and instead, educate, guide and empower. Often the user only needs to know what the next step they should take is.
• If you think the patient’s condition might not be mental health related, but an organic pathology instead, refer the patient to a medical consult.
• Do not give your personal opinion. Always keep the answer professional and based on scientific evidence.
  
  

Examples of Frequent Inquiries 

About Our Users

How Do They Find Out About Abi?

Some patients personally buy the service through our website (https://www.abiglobalhealth.com/ ) or through the website of an authorised distributor or partner.

Some patients are offered Abi for free by their health insurance provider, employer, public service or other payer. You will be notified in the question of the origin of the patient (private, insurance, etc).

How Do Users Access Abi?