Online care

Before the impact of COVID-19, few of us had ever encountered telehealth. But just like many active seniors, could virtual medicine now be here for the long haul?

Lauded as much for its convenience as it is for its safety, virtual medicine is changing the way we ensure our healthcare needs are met.

To date, telephone, email and video have been the primary mediums used to deliver assessments, diagnosis, treatment, monitoring and follow-up of patients remotely.

Designed to support face-to-face appointments, it rose to our collective consciousness after COVID-19 began challenging healthcare systems around the world.

According to the Australian Medical Association, telehealth now accounts for 20% of all doctor consultations funded by the Medicare Benefits Schedule (MBS).

Prior to March 2020, telehealth service offerings in Australia were generally limited to indigenous and aged care services where patients were more than 15km from their GP.

However all that changed with the arrival of COVID-19 where, as part of its pandemic response, the federal government temporarily increased access to more than 280 bulk billed telehealth and telephone services, and fast tracked electronic prescribing of medicine.

Services featured in the revised MBS schedule include general practitioners (GPs), specialists, allied health and nurse practitioner appointments and after-hours consultations, chronic disease management, pregnancy support counselling, services to patients in aged care facilities and mental health treatment.

Australians proved quick to embrace telehealth services, and the use of telehealth soared. It was credited with helping to stop the spread of the virus, and in turn helping to save lives by protecting both patients and frontline health professionals.

It also helped spur innovation when, eager to find new ways of communicating, South Australia Health amped up its digital health offering by making available Microsoft Teams to 40,000 of its staff to build its remote working capabilities.

The Royal Prince Alfred Hospital in Sydney took a different approach and instead capitalised on increased demand for telehealth services by opening the country’s first virtual ward in a purpose-built space on the hospital campus.

How long has it been around?

Despite popular opinion, the delivery of health care from a distance is not a concept introduced solely to help stop the spread of COVID-19.

Prior to COVID-19, GP telehealth services in Australia were underutilised and occurred in three main contexts: in accordance with existing MBS item numbers; through hospital outpatient departments; or as part of commercial services where patients paid the full cost for their consultations. The temporary MBS item numbers made it much more accessible.

Due in part to the fact its population is so dispersed, Queensland has been the country’s leader in telehealth implementation and research for many years.

For some time now, telehealth has been used as back up to the Royal Australian Flying Doctor Service, while organisations such as BUSHkids have implemented telehealth to communicate with children and families living remotely who wouldn’t otherwise have access to such services.

From 2003 to 2019, the state even had its own Centre of Research Excellence in Telehealth.

However as recently as 2018, many medical experts were lamenting Australian doctors’ slow uptake of digital health technology and investigating new ways to bring specialists into the computer age.

Does it work?

CEDA, the Committee for Economic Development of Australia, commissioned independent, not-for-profit organisation the Sax Institute to investigate 20 different reviews that had been done on telemedicine and virtual hospitals.

Its findings revealed the efficacy of virtual services was positive – unless you are a cancer patient or one who has respiratory disease.

“These studies largely found that the interventions were either as good as or better than usual care at reducing hospitalisations, re-admissions, emergency department visits and length of stay,” CEDA found.

Clinically, studies again showed outcomes as good as usual care for heart-related or all-cause mortality, as well as for quality of life, hypo- and hyperglycaemia, BMI, cholesterol levels, blood pressure and mental health.

CEDA says the evidence also suggests that tele-monitoring, or the electronic transmission of health data, could have a significant impact on all-cause and heart failure related mortality.

“Overall, we found that the strongest clinical evidence for tele-healthcare and tele-monitoring was for patients with heart failure or coronary artery disease, for diabetes and for stroke rehabilitation. There is not so much evidence around its efficacy for cancer, and the evidence for respiratory disease was not conclusive.”

Will it stay?

October’s federal budget confirmed a six-month extension of Medicare subsidies for telehealth consultations to March 2021, part of which included $18.6 million for the preparation of permanent telehealth infrastructure beyond that period.

The Australian Medical Association has also thrown its weight behind the permanent adoption of telehealth arguing it will reduce costs across the health system while improving patient outcomes.

“Travel costs, including fuel, meals, and potentially accommodation increase with patient rurality, and can present a barrier to accessing care,” AMA says.

“Telehealth can also reduce the cost of providing health care when considering the costs associated with health professionals needing to travel for home visits, and the cost to the government for rural aeromedical evacuation and health care in institutions like correctional facilities.”

Anecdotal evidence suggests that older Australians are gunning for continued access to telehealth now and into the future.

A report released in September by the Global Centre for Modern Ageing (GCMA) found that Australia’s active seniors had embraced the move to telehealth services and were happy to continue using the service post-coronavirus.

The report, Telehealth – Here to stay, found that one in five older Australians (20%) reported taking part in an online appointment or consultation with a health professional during COVID-19.

When it came to phone and online consultations, 85% of older Australians felt the quality of care/treatment provided during their telehealth experience was the same or better than a face-to-face consultation.

The report also showed 67% of Australians aged 60 or over who had used telehealth during the pandemic felt confident to use it in the future and nearly one in two of those surveyed say they are likely to use it after the pandemic.

However the news about telehealth wasn’t all sweetness and light, with 38% of Australians aged over 60 noting they had experienced “some” concerns and difficulties using telehealth. These issues included:

 - An inability to have a problem examined/receive usual treatment

 - A less personal experience due to lack of body language and cues, less perceived warmth and less perceived care

 - Challenges for people with hearing impairment

 - Awkwardness, especially with a new clinician

 - Tech glitches, lack of appropriate tech and lack of tech confidence.

In recognising some of the benefits of telehealth, the key representative body for Australian general practitioners The Royal Australian College of General Practitioners (RACGP) says providing on-demand telehealth services to patients may result in less time and fewer resources spent on routine care, including fewer routine home visits.

It also offers improved access to care for patients with mobility issues and reduced patient costs as a result of savings on transport.

However it argues that telehealth also presents a number of risks to both GPs and patients particularly when a patient is not known by the GP or practice offering the service.

This could result in fragmented or compromised quality of care as a result of an increased likelihood the service will focus solely on the issue presented by the patient and the opportunity to provide additional primary preventive care may be missed.

The industry group also says the provision of some advice or medicines without a physical examination or access to documented medical history can also potentially compromise continuity of care and best practice principles and says these situations may result in fragmented care and poor health outcomes.

When all is said and done the RACGP says maintaining continuity of care is essential, “irrespective of whether a service is provided face-to-face or by telehealth”.