Dissecting the rise of single-issue telehealth

For those living remotely, who struggle with mobility, need specialised services, or are simply too busy, recent advances in telehealth have been a lifesaver.
 
While the benefits of telehealth are clear, its rise to prominence has brought with it fresh concerns about continuity of care and fragmentation, and overall quality.
 
Among the concerns raised by GPs is the emergence of single-issue telehealth providers, practising in one specific area, such as smoking cessation, weight loss, medical certificates, or medicinal cannabis.
 
RACGP President Dr Nicole Higgins told newsGP it is vital any online service is operating within the expected quality and standards frameworks.
 
‘Many of these services aren’t staffed by GPs, they’re staffed by doctors who aren’t trained as specialist GPs, and as a consequence, many of these are business opportunities versus being healthcare providers,’ she said.

‘Sometimes it feels like the wild west, where people are making the rules as they go, and it’s being driven by businesses instead of innovation and care.
 
‘We need to strike the balance between quality and safety and business-driven demand, between where heavy marketing and profit is the goal versus providing a healthcare solution.’
 
At the peak of the COVID-19 pandemic, telehealth was pushed to its limit, forced to rapidly expand to accommodate a new world where face-to-face consultations were deemed impossible almost overnight.
 
Between March 2020 and July 2022, 118.2 million telehealth services were delivered to 18 million patients, and more than 95,000 practitioners used the service for consultations.
 
And on 1 January 2022, expanded telehealth services became an ongoing part of Medicare, with a range of providers allowed to deliver it, including GPs, specialists physicians, allied health providers, mental health professionals, and nurse practitioners.
 
Since then, it has cemented itself as a crucial addition to Australia’s healthcare offerings and is already changing the way patients seek out treatments, including on issue-specific websites.
 
The widespread availability of prescription-only nicotine products online is one area causing concern, with the Therapeutic Goods Administration (TGA) confirming to newsGP it is assessing several websites.
 
On 1 January, the Federal Government banned the importation of all disposable vapes, while on 1 March, it banned the importation of all vapes, except when an importer has a specific permit or licence.
 
Consumers now require a prescription for all purchases of vapes containing nicotine, which are often available via a telehealth consult.
 
Similarly, telehealth websites are emerging to prescribe the Tik Tok famous drug, semaglutide (sold as Ozempic), despite its worldwide shortage and warnings from the TGA for doctors not to initiate any new patients.
 
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, said with some telehealth providers only offering this limited range of products, patients are not given a full set of options.
 
‘Pop-up, narrowly focused health providers are mostly out to sell products rather than focused on holistic health needs of people,’ he told newsGP.
 
‘Some focus on providing necessary bits of virtual paper in the form of sick notes or referral letters.
 
‘While these might comply with legislative requirements, they hardly represent thorough medical care or comprehensive information exchange between referrer and specialist.’
 
However, some single-issue services have come highly praised, with one example being access to pregnancy terminations, especially for women once unable to access timely healthcare.
 
Dr Higgins said telehealth is a vital addition to the healthcare system, allowing patients better access and choice, but it must be driven by a health-first approach.
 
‘At the moment, it is a mixed bag, and that inconsistency and lack of standards is a really important issue,’ she said.
 
‘Consumers often aren’t making informed choices because they don’t necessarily understand what the service is offering, so we need to make sure we empower consumers to be able to make those informed decisions.’
 
According to the Australian Institute of Health and Welfare, between 2015–16 and 2019–20, almost 90% of Australians attended at least one Medicare-subsidised GP consult.
 
This figure dipped to 85% in 2020–21 as COVID-19 restrictions were introduced but rose again the next year when telehealth appointments were more streamlined.
 
The RACGP has previously called for telehealth services to be bolstered to ensure they are always delivered by trained medical professionals.
 
But as patient interest in telehealth continues to grow, many are now calling for the available offerings to be expanded.
 
Last month, West Australian Independent MP Kate Chaney called for changes to the Criminal Code to allow for voluntary assisted dying consultations to be delivered via telehealth – a plan the Federal Parliament will debate at a later date.
 
And despite her overwhelming support for telehealth services, Dr Higgins said it can be frustrating when those appointments impact her patient’s continuity of care.
 
‘One of the things about general practice is knowing when to say to somebody, “this isn’t a good idea because of x”, or “I’m saying no because it’s going to cause a problem with another medication or another medical problem”,’ she said.
 
‘It is frustrating if patients have an expectation about an outcome, or shop around until they get what they want.
 
‘Telehealth is such an important part of general practice that we need to continue to embrace it but continue to have that dialogue with patients around safety and also around consent’.
 
Professor Morgan agrees, saying general practice remains the best place for patients and doctors alike to share decisions and access the health information specific to their personal needs.
 
‘GPs are ideally placed because of knowledge of the person’s past medical history, social context, current comorbidities, and any medications,’ he said.
 
‘When a product is prescribed, typically the prescriber takes some responsibility for ensuring the prescription is safe, there are opportunities for follow up, and non-drug components to a treatment plan should ideally complement the prescription.
 
‘It seems none of these components of care are a part of online tick-box “consultations” prior to product purchase and delivery.’
 
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