Report highlights value of telehealth phone consultations

At the start of the COVID-19 pandemic there were concerns patients would see their GP less often.
 
But NPS MedicineWise’s fourth General Practice Insights Report has found the opposite to be true, with patients consulting their GP more often in 2020 that the previous year.
 
The report analysed data from general practices and patients featured in the MedicineInsight Program, including 458 practices, 4026 GPs, and 2.47 million patients over the course of March to December 2020.
 
While the number of in-person consultations billed to Medicare was lower (6 million) than in 2019 (7.7 million), the inclusion of telehealth saw the total number of billed consultations jump by 11% – with 8.6 million consultations in 2020.
 
‘This may have been because telehealth consultations reduced patient barriers to accessing care,’ the report notes.
 
RACGP President Dr Karen Price said the introduction of telehealth, which the college strongly advocated for, was clearly a ‘masterstroke’.
 
‘We could have been in a much worse position today without the introduction of Medicare rebates for telehealth in 2020,’ Dr Price said.
 
‘It ensured GPs could continue providing essential care to patients in challenging times, throughout COVID-19 outbreaks and lockdowns.’
 
With the expansion of telehealth in March 2020, rapid uptake was noted among practices and patients, resulting in 2.5 million (29.3%) GP telehealth services being billed to Medicare between March and December 2020.
 
After the initial peak, patterns of use varied across different states and territories, but a substantial increase was noted in Victoria during the second wave of COVID-19.
 
Rates of telehealth use were also found to be higher in inner regional than in major city practices, which the report notes ‘may reflect the greater access to healthcare among major city patients’.
 
The overwhelming majority of telehealth services (95%) were provided by telephone compared to 2.6% via video.
 
Use of video technology was found to be consistently higher in the most socioeconomically advantaged areas. For example, in April 2020 when video use was at its highest, 17.4 per 1000 clinical encounters took place over video in the most socioeconomically advantaged areas compared to 7.9 per 1000 in the most disadvantaged.  
 
Dr Price said she is not surprised by this finding, which is in large part why the RACGP has long expressed that telephone consultations are an important part of patient care.
 
‘The fact is many patients are either not comfortable accessing video consultations or are unable to do so, particularly those who are older, economically disadvantaged, or living in rural and remote areas,’ she said.
 
‘This is why the RACGP is calling on the Federal Government to make Medicare items for longer telephone consultations, mental health, and GP management plans part of the permanent telehealth model.’
 
The report also features insight on how often patients visited their GP, the conditions they have, the medicines they were prescribed and the tests they undertook.
 
It found that each patient had 5.4 GP encounters on average, up from the 5.1 encounters reported in NPS MedicineWise’s 2018–19 report, and female patients attended more often than males in most age groups. 
 
Hypertension was the most common condition (5.8% of patients), followed by lower back pain (3.9%), gastro-oesophageal reflux disease (GORD) (3.7%), asthma (3.5%) and dyslipidaemia (3.2%).
 
The number of MBS items billed for mental health treatment plans also increased, with anxiety disorder the most commonly recorded (5% of all patients) followed by depression (4.8%), bipolar disorder (0.4%) and schizophrenia (0.3%).
 
Though the use of telehealth MBS items has fallen from the peak observed in April 2020, the report notes that it may be the result of telehealth items being introduced for mental health treatment plans, which may have ‘improved access to care for the historically underserved population of patients with mental illness’.
 
Meanwhile, rates of medical and pathology testing decreased in March 2020, and prescribing of medicines for many chronic conditions, including heart disease and diabetes, simultaneously increased.
 
The report notes that this may be due to people trying to ensure they had enough medicine supplies before lockdown, with rates of prescribing and testing later returning to pre-pandemic levels from June 2020.
 
Dr Price said it is positive that Australia managed to escape the major decline in primary care services – and the associated impacts on patient health – that other countries experienced in lockdown, largely thanks to the expansion of telehealth.
 
‘Telehealth has been embraced by GPs and patients alike and has proven to be a valuable complement to face-to-face care – I know from my own practice how valuable [it] is,’ Dr Price said.
 
‘The fact that patients can still access care in such challenging and stressful times, be it for an ongoing chronic condition or mental health concerns, makes a world of difference.
 
‘The report also supports what GPs know anecdotally – that telehealth has improved access to care for regional communities in particular.’
 
The Government announced in December 2021 that telehealth would become a permanent fixture of Australia’s healthcare system.
 
Dr Price said she looks forward to being part of the consultation process to ensure the long-term plan is right for all patients, right across the country.
 
‘The introduction of telehealth was progressive policy, responding to the needs of the community – it no doubt saved lives in 2020, and it still is,’ she said.
 
‘[But] longer telephone consultations must be a permanent fixture of telehealth to improve access to care for all patients.’
 
The RACGP was a member of the advisory group for NPS MedicineWise’s fourth General Practice Insights Report, which was commissioned by the Department of Health.
 
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