Telehealth patients missing out on pathology

Anna Samecki

1/12/2021 4:36:56 PM

While telehealth use has risen sharply, these patients are less likely to access pathology services, a new study suggests.

A patient giving blood.
Only 5% of telehealth patients were given a referral for a blood test compared to 10% of patients attending face-to-face consultations.

Telehealth has risen sharply in the wake of the COVID-19 pandemic, with more than 54 million telehealth consultations being delivered Australia-wide between March 2020–21.
But a new study, led by the Australian Institute of Health Innovation (AIHI) at Macquarie University, has revealed that patients using telehealth to consult with their GP are less likely to be referred for pathology tests compared to patients presenting in-person.
Researchers analysed more than 37 million GP consultations delivered across 807 general practices in NSW and Victoria and found that only 5% of telehealth patients were given a referral for a blood test (defined as any test requiring blood draw) compared to 10% of patients attending face-to-face consultations.
The authors of the study state that the lack of a standardised way for GPs to complete pathology referrals digitally has contributed to the service gap, and that many pathology providers still prefer hard copies which poses a barrier.
Lead researcher Dr Rae-Anne Hardie told newsGP barriers faced by patients attending pathology providers who require physical forms include:

  • the need to physically attend the general practice to pick up a test referral after their telehealth consult
  • needing to have a printer or fax machine at home to print out emailed referral forms, which is also a potential security issue
  • needing to wait for a form to arrive in the mail or needing to make additional phone calls to pathology providers 
  • GPs having to arrange for the delivery of electronic forms to the correct labs.
‘GPs involved in this study indicated that there is a lack of standardised electronic referral options offered by pathology labs and that those offered do not necessarily work well with their clinical workflows, resulting in workarounds,’ Dr Hardie said.
‘Most patients choose to have a telehealth consultation due to health or safety concerns, convenience, or because of COVID-19 restrictions, making it unlikely they will be willing or able to collect a paper-based pathology referral in person following the consultation.’
With telehealth still in high demand, the authors say service gaps such as this need to be addressed if it is to remain part of routine healthcare in Australia.
In addition to poor integration of digital referrals into telehealth, Professor Paul Glasziou, Director of the Institute for Evidence Based Healthcare at Bond University, told newsGP several other factors are likely to have contributed to the findings.
‘The overall drop [in pathology referral rates] is in line with what has been seen generally in the pandemic,’ he said.
‘The difference in rates of pathology is most likely due to differences in the seriousness of illness between face-to-face and telehealth visits.’
Sydney GP Dr Angela Rassi, who continued to work throughout the pandemic, including the recent lockdown period, agrees.
‘Telehealth is used more often for simple consultations such as scripts or specialist referral letters,’ she told newsGP.
‘It is also used as a screening tool for respiratory symptoms.
‘More complex consultations might be conducted over the phone initially but are usually then concluded in person with an examination before referral for pathology investigations.’
While imaging referrals were not included in the study, it is probable that a similar trend exists, as has been observed between telehealth and face-to-face consultations when comparing rates of medication prescribing during the pandemic.
However, while the study suggests a need for better integration of pathology referrals into telehealth consultations and enhanced utilisation of e-referral technology where appropriate, the authors indicated that it also has a number of limitations.
Only pathology results from fulfilled requests were included, which could have underestimated the actual number of blood tests requested, while some non-blood test referrals may have gone undetected in the study sample.
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Dr Steven Hambleton   2/12/2021 10:49:41 AM

In Qld Sullivan Nicollaides Pathology, a branch of Sonic, has facilitated e-Pathology referrals. Step one is have GBR (guidance based requesting) or e-requesting turned on (I use Best Practice) and add the word "telehealth" in the clinical notes section. If the patients mobile number is included in the demographics - hey presto they receive a text message containing the pathology request. Simple. No fax, no post, no email.

Dr Anna Maria Samecki   2/12/2021 4:34:15 PM

Great to hear Dr Hameton! Hope clinics take note and consider incorporating similar methods in the future to aid their workflow.