We welcome the Commonwealth Government’s announcement last week that it will invest $2 billion to extend a range of COVID-19 health measures until 31 March 2021, including Medicare-subsidised telehealth for GP and essential specialist services.
The background
As you may be aware, we asked you about the future of telehealth in our recent survey and we’ve been pressing the Commonwealth Government to make it an integral part of our healthcare system.
The speed and efficiency with which our members have embraced telehealth during the COVID-19 pandemic has been outstanding. We see it as just one example of how you have gone above and beyond to deliver healthcare to your patients.
In recognition of the challenges associated with integrating telehealth into practice so quickly, over the past six months, we have focused on providing you with resources to reduce the medico-legal risks associated with COVID-19, including telehealth. Our COVID-19 information and FAQs have received over 110,000 page views.
Why did we run a telehealth survey?
We wanted to get feedback on your interest in telehealth, as well as how to minimise medico-legal risks and make it safe for both doctors and patients.
The survey ran from 8-15 September 2020 and asked about your experiences of telehealth, including the challenges you currently face.
Who did we survey?
The survey was sent to members across all specialities and career stages, including trainees.
What kind of response did we receive to the survey?
We would like to thank you for the incredible response to the survey.
We had over 1,300 responses from members who consult with patients. Just over half of respondents were GPs. The remainder were physicians, surgeons and other doctors.
We understand that this makes it the largest survey on telehealth conducted in Australia.
What did you tell us?
Almost all respondents (96%) said they provide telehealth consultations (phone/audio or video).
Should telehealth continue after the COVID-19 pandemic?
Most respondents (87%) were interested in continuing to use telehealth if there was ongoing MBS funding.
Some of the specific comments on the benefits of telehealth included:
- “I was sceptical at first but am surprised how much can be achieved over the phone. Being able to bring them to the clinic for examination is crucial. It has kept me safe & employed!” (GP, Victoria)
- “Improved access and utilisation of Telehealth has been the largest positive to come from the pandemic by far.” (Physician, Victoria)
- “It's incredibly useful allowing both patients and GPs to be able to quickly and effectively follow up on consultations, results, prescriptions and referrals when required. Patients have commented on how useful it is, particularly around accessing timely care and advice for serious medical conditions.” (GP, Western Australia)
- “Great tool specially for follow ups and triage.” (Surgeon, Victoria)
- “The longer it has been in use and the more acclimatised patients and I have become, the more positive comments I am hearing and the more wish that it continues as an option.” (Psychiatrist, Victoria)
Are both doctors and patients struggling with the technology?
Despite the Department of Health guidelines specifying that a telephone consultation should only be used where audio-visual consultation is unavailable, the levels of video telehealth are still low on average compared to audio/phone telehealth. In the four weeks prior to the survey, respondents who provide telehealth reported an average of 34% consultations on audio/phone compared to 17% on video.
Interestingly, for 61% of respondents, the technical ability of patients was a barrier to using video telehealth more, or at all.
For 25% of respondents, their personal preference prevented them from using or more frequently using, video telehealth with their patients.
What do you cover at the start of a telehealth consultation?
We were particularly interested in how our members were handling the key processes associated with conducting telehealth consultations.
When it came to confirming they were speaking to the right person, 92% of respondents said they checked this.
While 68% of respondents obtained consent for a telehealth consultation, only 20% covered what to do if the connection was lost.
Finally, 32% of respondents said they discussed the billing process with patients and, unsurprisingly, only 11% covered guidelines around making an audio or visual recording of the consultation.
Have you received sufficient training in how to use telehealth?
Most respondents who provide telehealth (73%) said they had not received any, or enough, education/training in how to conduct telehealth consultations.
More than one third of respondents who are providing telehealth (37%) do not have guidelines, or sufficiently clear guidelines at work to determine who should be offered a telehealth consultation.
What about the experiences of trainees?
Many trainees (54%) who do telehealth consults felt they were not exposed to the same learning opportunities when using telehealth. A common reason given for this was the inability to physically examine patients.
Of those trainees who felt the opportunities were the same (46% of them), some commented about the benefits of training via telehealth, including:
- “It enhances my history taking and problem solving skills which are great learning opportunities.” (GP registrar, Queensland)
- “Providing care to patients via telehealth is a skill in its own right it focuses on history taking accurately and managing a patient at a distance.” (Physician in training, Victoria)
- “It enhances communication skills with patients to conduct a consultation without non verbal cues.” (Surgeon in training, Queensland)
Most trainees (63%) said they were ‘usually’ able to access supervisor support during a telehealth consultation, although for some (33%), support was only accessible ‘sometimes’.
Are doctors receiving complaints linked to telehealth?
It is concerning that 5% of respondents said a patient had made a complaint to them (or their workplace) that they believe was a result of telehealth.
These complaints related to a variety of issues, including:
- billing disputes when patients didn’t think they should pay for telehealth
- patient’s wanting to have a face-to-face instead of a telehealth consultation
- misunderstandings due to the lack of non-verbal cues.
Some of the specific comments regarding complaints included:
- “Went to inform patient re cost of the consult and they were offended by this as were expecting to be bulk- billed even though they did not qualify.” (GP, South Australia)
- “Several patients have expressed their unhappiness with TH [telehealth] process as they would much prefer to see their GP and they offended / alienated / disadvantaged by the inference that they may be infectious. Once an explanation is given re patient & staff safety measures, most are placated.” (GP, Victoria)
- “Patient wanted a face to face appointment, but I was doing all telehealth.” (Physician, Victoria)
- “Not accepting advice unless seeing doctor face-to-face.” (Physician, Queensland).
What next?
It seems likely that the Commonwealth Government’s decision to extend Medicare-subsidised telehealth until 31 March 2021 is a good indication that telehealth will become a permanent part of the health system.
This survey demonstrates there is an ongoing need for education for doctors, as well as additional support for patients in order to facilitate the use of video in consultations.
Avant will continue to urge the Commonwealth Government to implement policies that will secure the safe and effective use of telehealth in Australia. In addition, we will provide further education for our members that will help you to reduce your medico-legal risks when consulting with patients via telehealth.