Telehealth has played an important role during the pandemic. Telephone and online consultations have enabled social distancing and kept patients and clinicians safe from transmissible infections.
Since the start of COVID in March 2020, there have been 122 million telehealth consultations funded through Medicare. About 90% of these services were provided by general practitioners (GPs), with nine out of ten of these consults done as a telephone call.
Online services for prescriptions and medical certificates have become available to consumers at the click of a button. Given the shortage of GPs, difficulties getting timely appointments, and clinic restrictions if patients have COVID-like symptoms, consumers seem to be welcoming these services. Patients can consult a GP by telephone or video call, and then receive an electronically dispatched medical certificate or prescription (if clinically appropriate).
These services are either paid for partially, or totally by the consumer, with limited Medicare rebates available. They are fast, convenient and readily available. But what do consumers need to know about their pros and cons?
On the plus side…
Offering services online means ease of access and convenience. We have seen this in the banking, retail and travel industries. Who wants to wait three days for a GP appointment, spend two hours in traffic and one hour in the waiting room, for a short consultation?
Access to care
When providing health services, we have to think of our whole population (see points below on equity). These instant services offer greater convenience and benefits for those who find it hard to access transport, are time-poor, or who find it difficult to leave the house (such as parents of little kids or people with other physical disabilities or mental health concerns).
Reduced wait times
If it isn’t possible to get an appointment with your regular GP and you need a medical certificate for work, these services may be a good fit. They also enable acute conditions to be managed in a timely manner, for instance by getting a script for tablets to stop vomiting.
Reducing congestion in hospitals and medical centres
These services also reduce pressure on primary care services and hospitals. If someone can be supported by an online service instead of visiting an emergency department or urgent care centre, then the bricks-and-mortar hospitals, clinics and medical centres remain available for people with more serious health needs.
But there are also downsides
Continuity of care
The downside is you may risk losing continuity of care, as you are not necessarily going to be seeing your own GP online. If you have complex health needs or chronic conditions, it is better you have a primary care provider who knows your history and can manage your health condition holistically.
Access to a complete health history
Australia doesn’t yet have a single complete and integrated information system for sharing all personal health information. So when you access these services, it is often your responsibility to share health information with the provider and also inform your GP about your online appointment.
However, communication systems are improving slowly, and a summary may be shared electronically with your nominated GP after your consultation. For patients who have opted in to My Health Record, some of this communication will happen automatically.
There are limits to the types of services that can be provided online or by phone. You may need an in-person appointment, especially if a physical assessment is required, or the concerns are more complex than anticipated. GPs adhere to guidelines and practice standards irrespective of how services are delivered. For instance, provision of e-scripts and medical certificates require documentation and screening measures to ensure appropriate care is provided.
Online or telehealth services aren’t suited for starting new medications that require monitoring or might have side effects.
New medications for chronic conditions should ideally be started by someone who you can see you again to check they are working and manage potential side effects or reactions. Additionally, there are medications (such as strong pain relief) these services won’t prescribe, and consumers need to see an GP in person to obtain.
Medical certificates aren’t just for your boss
Local pharmacists can write medical certificates for single days and assist with advice and medications for minor health issues. However, they cannot write prescriptions.
The aim of a medical certificate is to satisfy an employer. But getting a medical certificate may also be an opportunity to have symptoms checked and make sure there is nothing seriously wrong.
Online services make accessing a medical certificate for the flu or gastro much more convenient. However, if people are having ongoing health issues that require regular time away from work, they should be seeing a regular GP to help manage their condition.
Online doesn’t mean equal access
There is the risk of inequity of access for these services, especially for consumers who don’t know how to access them, can’t afford to pay, or do not have access to the necessary technology (including reliable internet).
A recent paper suggested ways to tackle this digital divide. These included improving digital health literacy, workforce training, co-designing new models of care with clinicians and patients, change management, advocacy for culturally appropriate services, and sustainable funding.
Other points to remember
Finally, consumers need assurance that health services are provided by suitably qualified health professionals. This is usually achieved with confirmation of health provider credentials prior to, or at the start of, the consultation.
Consumers can also look up their provider through the Australian Health Practitioner Regulation Agency (Ahpra) where all clinicians are registered.
Consumers should also look for an Australian service to ensure it adheres to Australia’s quality standards and clinician registration criteria. This is also important because of the Australian standards around personal data collection and storage. Consumers should read information provided by services about their data policies.
As with all health care, it is about finding the right balance and ensuring services align with clinical indications.
Telehealth is not about replacing in-person appointments. Telehealth should be used in conjunction with face-to-face advice, to maintain high-quality care that best suits the needs and wishes of the consumer.