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    Issue 14

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    Pros and cons of telehealth

     

    Dr Penny Browne

    MBBS, FRACGP, MHL

    Chief Medical Officer, Avant

     
    telehealth doctors view

    In a significant change for some in the profession, the Government introduced new telehealth reforms to allow ‘whole of population telehealth’ during the COVID-19 pandemic.

    Since then, there have been 9.1 million1 telehealth consultations. A survey by the Royal Australian College of General Practitioners (RACGP) found 99% of practices were offering telehealth, so we asked RACGP President Dr Harry Nespolon and two members, how telehealth was being received and its future in healthcare.

    Digital health transformation

    The introduction of the telehealth rebates has been welcomed by the RACGP and Dr Nespolon stated, “We’ve been lobbying for 10 years for a form of digital health”. Consequently, he wants to see funding retained after its proposed end date of the 30 September.

    The number of telehealth consultations noted above makes up around a quarter of all GP consultations, though nearly all practices the RACGP surveyed are offering both face-to-face and telehealth. “This is what we want to see happening as telehealth isn’t the answer to every problem,” Dr Nespolon says.

    “A pure telehealth service doesn’t deliver the care that patients need. However, it improves the efficiency of practice and is something patients want,” he adds.

    “What that looks like in the future will depend on the rebates. To date, we’ve only had rebates for face-to-face consultations. If it goes forward, there are likely to be different rebates for phone and video telehealth.”

    ...clearly you do lose a lot when you can’t see the patient, even with video.


     

    "About 90% of consultations have been delivered by telephone so far and we need to move away from that and more to video. Video is much more complicated to set up as you need the patient in front of a laptop or phone somewhere quiet."

    On the introduction of telehealth, Dr Nespolon notes, “It was set up in a rush and we weren’t quite ready for it, but it has helped with COVID-19. It kept patients safe and doctors safe and minimised the use of PPE. GPs haven’t had a lot of training on how to deliver telehealth properly and we need to educate patients as well.”

    Commenting on the pros and cons of telehealth, Dr Nespolon says it “offers people opportunities to deal with issues they might find difficult face-to-face, but clearly you do lose a lot when you can’t see the patient, even with video.”

    When looking forward to further digital health developments Dr Nespolon notes, “There needs to be better infrastructure. We are still faxing and hand delivering prescriptions and need to get the technology going now and build it into our practices. It needs to move from 2007 when the first iPhone came out, to 2020. There are much better ways of delivering care and this might be the beginning of some footsteps in the right direction.”

    Member perspectives

    Some doctors are adopting telehealth for the first time and had to learn how to implement the technology, as well as familiarise themselves with the item numbers whose requirements evolved over time (see Transitioning to the telehealth era article).

    Here, two members provide their experiences with telehealth, a GP first-time user and a cardiologist who has used telehealth for several years in remote areas.

    The telehealth newbie

    Dr Glynn Kelly, a Brisbane GP, started performing telehealth consultations from his home in April.

    He believes telehealth has been invaluable during the pandemic and as a ‘vulnerable doctor,’ it has permitted him to continue working, take the workload off his practice and provide his patients with extra support.

    “The positive is I can still see my own patients who are like family to me,” he says.

    While Dr Kelly would prefer to see his patients face-to-face, he says the telehealth consultations – conducted via telephone as most of his patients don’t have access to video – are a good way to “touch base” with his patients.

    Commonly, Dr Kelly uses telehealth to follow up with patients and discuss results, for example. However, many issues have to be dealt with by face-to-face consultations in the surgery. With both formats, good medical practice must always be followed, including good quality clinical notes.

    As to whether he will continue doing telehealth consultations after the pandemic is over, he is frank. “Although, I don’t find telehealth consultations as professionally satisfying as doing them face-to-face and talking with the patient, I strongly believe the telehealth MBS item numbers should be permitted to be used after the pandemic. I don’t see why a frail old patient has to routinely come into the surgery when many issues can be well assessed and dealt with by telehealth”, Dr Kelly says.

    The telehealth veteran

    Dr Andrew Rainbird, a cardiologist, offers a different perspective, having performed telephone and video-conference consultations with patients in remote areas for several years.

    The real advantage of telehealth consultations, he believes, is as a screening tool to determine which patients warrant investigation in a major centre or for following up patients with pathology so they don’t have to travel to a major centre.

    Like Dr Kelly, he also avoids consulting new patients via telemedicine. “The clinical examination is an important part of cardiology, so it’s difficult to perform telemedicine on new patients without actually physical contact with them,” Dr Rainbird says. “Usually I see the patients in person and then it might be following-up on test results, reviewing ECGs, reviewing medications, remote monitoring of their pacemakers or defibrillators, or discussing their management plan.

    COVID-19 has had a significant impact on Dr Rainbird’s practice and he is now doing more telehealth consultations than ever.

    “Due to the pandemic we have significantly increased the number of telehealth consultations we are doing over the phone, particularly for elderly and immuno-compromised patients to keep them at home and minimise the risk of transmitting the coronavirus to them and staff,” he says.

    As for the future of telehealth, Dr Rainbird says doctors and patients will have to accept that the technology is here to stay.

    Useful resources

    References

    1. Department of Health verbal comment on Friday 15 May, provided by Dr Nespolon.

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