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Expanded COVID antivirals access hindered by telehealth restrictions


Matt Woodley


11/07/2022 5:00:51 PM

While more people are now eligible to receive treatment through the PBS, GPs warn that vulnerable patients risk being left behind due to a lack of MBS support for extended phone consultations.

GP on the phone.
GPs says it is impossible to conduct a proper COVID antivirals consultation in under 20 minutes.

Millions of extra Australians should now have access to potentially lifesaving COVID oral antivirals, thanks to a Pharmaceutical Benefits Advisory Council (PBAC) decision to expand eligibility to everyone over 70.
 
However, doctors are warning that some patients – particularly the elderly and people living in remote and rural areas – may still struggle to access the medication after the Federal Government removed Medicare rebates for longer general practice phone consultations on 1 July.
 
Queensland GP Dr Maria Boulton told newsGP the new telehealth restrictions are having a ‘particularly detrimental effect’ on vulnerable patients.
 
‘Why are we discriminating against people? Especially when we are in the middle of a third COVID wave,’ she said.
 
‘There are areas where patients and doctors do not have fast speed internet which is what video consultations require. There are people who cannot access video services due to a lack of fast speed internet, smartphones or tablets, etcetera.
 
‘It is also difficult for those who are not familiar with the technology to manage when they are unwell.
 
‘A COVID consultation where you check in on the patients, screen them for concerning symptoms, discuss their symptoms, discuss safety net, discuss whether they are eligible for antivirals and check for interactions is likely to be longer than 20 minutes.
 
‘Patients deserve access to long consultations.’
 
It is a position supported by the RACGP, which has consistently advocated for Medicare-supported phone consultations longer than 20 minutes to be a permanent part of Australia’s telehealth system.
 
College President Adjunct Professor Karen Price again wrote to Federal Minister for Health and Aged Care Mark Butler on Monday 11 July to call for their ‘immediate reinstatement’.
 
‘RACGP members have told us that the removal of rebates for longer phone consultations increases access issues and health gaps for specific groups, including Aboriginal and Torres Strait Islander people, elderly people, people with disability, people with mental health concerns, and rural populations,’ she said.
 
‘Many patients in these groups have poorer health outcomes than the general population and want to avoid visiting a practice in-person where possible to protect themselves from COVID-19 and other illnesses.
 
‘These patients are also more likely to be bulk billed, placing GPs at a financial disadvantage by restricting claiming to lower rebates for providing complex care.’
 
Adjunct Professor Price also explained how longer phone consultations are ‘critical’ for the management of COVID patients who are prescribed antivirals.
 
‘GPs require additional time during consultations to establish eligibility for antivirals, determine which antiviral is best, consider any contraindications, and develop a treatment plan for the patient,’ she said.
 
‘Paxlovid in particular has an extensive list of contraindications and drug interactions that the prescriber is required to check. This is important for patient safety but time-consuming and impossible to do in under 20 minutes.
 
‘The majority of antiviral prescriptions require the safety and immediacy of telephone consultations. Given the number of COVID-19 cases currently in the community and the unknown impacts of long COVID going forward, enabling access to these longer sessions is vital.’
 
Another potential solution to access issues, put forward by Pharmaceutical Society of Australia President Dr Fei Sim, is to allow pharmacists to independently prescribe antivirals without the need for a GP.
 
However, Dr Boulton says this proposal would not increase patients’ access to antivirals as one of the main barriers, especially in rural and remote communities, is a lack of stock availability.
 
She also holds safety concerns.
 
‘Managing someone with COVID is not as easy as handing out a script,’ Dr Boulton said.
 
‘It involves screening the patient for serious symptoms, determining if there are risk factors for severe disease, assessing the patient’s symptoms and ensuring there are no contraindications with the treatment.
 
‘GPs may determine that some patients may need more specialised care in hospital. We also ensure there are no other at-risk people in the household. Some patients will also have issues with their renal function that needs to be reviewed prior to prescribing an antiviral.
 
‘The GP can ensure the patient is given the right advice as to red flags and when to seek help … [and] also determine when the patient should be followed up.’
 
RACGP Vice President Dr Bruce Willett has likewise said that the training, skills and clinical expertise that GPs have means are ‘key’ to safely prescribing the oral antivirals.
 
‘We have a strong and, in many cases, long-standing connection with our patients and understand their life circumstances, including existing health conditions or other factors such as plans to become pregnant,’ he said.
 
But on top of reinstating longer phone consultations, he also believes more needs to be done to fight complacency and contain the harm caused by COVID-19.
 
‘We are not out of the woods yet and this pandemic is not over,’ he said.
 
‘Expanding eligibility is vital; however, we must also enhance community awareness around treatments and ensure that those patient groups most likely to experience severe effects from the virus access these drugs.
 
‘People who believe they are eligible for a COVID-19 treatment should make an appointment with their GP now to plan how they can receive the drugs if they test positive.
 
‘With these treatments we must act quickly – they have to be given within five days, and they become less effective as you get closer to day five.
 
‘So, getting that message out there is essential, and I encourage everyone to have conversations with people in their life about these treatments.’
 
According to the most recent figures, around 63,000 courses of both COVID oral antivirals available in Australia had been prescribed via the PBS up to 26 June.
 
However, prescriptions rates across the various states and territories vary substantially – for example, COVID patients in the ACT are more than five times as likely to be prescribed the medications than those in the Northern Territory.
 
The Department of Health was asked what plans it has to improve access to the treatments outside of expanding eligibility but did not provide comment prior to publication.
 
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Dr Samantha Ann Bryant   12/07/2022 5:29:07 PM

Dear Medicare/federal health minister,
It does take more than 20 minutes to sort out how well unwell patients are with covid 19 and then check all their medications to see if they can have paxlovid, AND many at risk elderly patients cannot use Telehealth just telephone. So I did work some hours last week for no financial remuneration so that I could treat these vulnerable people anyway as I and many GPs have done throughout these lockdowns and health inequalities for our community. No wonder only 15% of the doctors trained choose GP training.