A COMPREHENSIVE national telehealth policy has been recognised by the government as a critical tool in protecting the wellbeing of patients and doctors in response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. As a practising GP in a Sydney clinic and online, I believe we as clinicians play a significant role in how these telehealth services are implemented safely and responsibly. I also see a real urgency in the rapid uptake of these measures as COVID-19 continues to affect Australia’s frontline clinics, hospitals and pharmacies.
The Health Minister has been rapidly increasing access to telehealth services in response to the SARS-CoV-2 pandemic. On 13 March, new Medicare Benefits Schedule items were applied to high risk patients and those diagnosed with COVID-19 or in self-isolation. Then new items enabled at-risk GPs to bulk bill telehealth for all consultations with their patients in a step to protect the vulnerable members of our medical workforce.
From 30 March 2020, the federal government has expanded the eligibility criteria for all patients, with or without COVID-19, to receive funded access to a GP or medical specialist via a telehealth platform during the COVID-19 health emergency. The large scale access to online GP appointments will certainly reduce the risk and burden in clinics, hospitals and pharmacies and be critical in the fight against COVID-19. As clinicians on the frontline, we now have the responsibility to consider best practice in implementing these services quickly and effectively. Below are some thoughts for consideration.
Patients are already online
In a world that is always on, I’ve found that concerned or sick Australians find reassurance in being able to connect to a qualified doctor online and as the SARS-CoV-2 pandemic has unfolded, I’ve seen patients increasingly initiate on-demand support from the safety of their own home.
As patients adopt self-isolation and even face imminent lockdown, the remote functionality of telehealth apps is attractive to minimise the risk of exposure to COVID-19 while seeking the clinical support they need. For patients, it’s as simple as logging in and starting a consultation immediately, at any time of day.
In 2019, the Royal Australian College of General Practitioners (RACGP) reported that only a third of GPs had consulted online in Australia despite telehealth being established within the health care services of remote and regional areas. To extrapolate from the RACGP’s findings, that means an estimated 25 000 GPs have yet to start consulting online (here, here and here). We must continue to be agile and attentive to the changing needs of the population by considering moving our services online at this time to address patient needs.
Patient safety remains our principal responsibility
The first step is to create a profile online via a telehealth platform provider and set up a smart device in a static position, either from home or in the practice. And while we can (like patients) simply log in and begin consultations immediately using telehealth, as clinicians, our guiding principle as always is patient safety. As per the Medical Board of Australia guidelines, we must initially determine the clinical appropriateness of providing the required care online.
Phone, text or video are all feasible depending on the clinical presentation of the patient. However, telehealth may not be appropriate for the management of all medical problems, and a face-to-face consultation may be required. Telehealth platforms provide a specialised COVID-19 pre-assessment tool to help identify the patient’s level of risk and support clinicians to quickly direct them to the most appropriate care.
Building therapeutic rapport
Although telehealth requires clinicians to learn new ways of consulting, building trust and demonstrating empathy are just as important online as they are in the clinic. Online appointments typically take 10–12 minutes, on par with an average appointment in clinic, so there is time to build therapeutic rapport.
While using telehealth, we need to continue, as always, to ask patients how they are feeling and identify their agenda, whether that is looking for a quick prescription or seeking advice and reassurance. During this challenging time, it is also important to directly address concerns around COVID-19 and provide online alternatives to arrange tests and referrals if necessary.
Another key query that I often hear is regarding physical examinations. Once confident that the patient is in an environment in which they are comfortable in to self-examine, explain in simple steps how to measure common medical tests, such as pulse or respiratory rate. Ask the patient to use the video function on their smart device to show visible symptoms and encourage them to describe how touch or movement feels. As we would in clinic, clinicians can then take the necessary action to ensure the patient receives the care they need, whether that is online or face-to-face treatment.
Continuity of care
Finally, telehealth services are designed to complement the care patients usually receive face-to-face and provide a platform for us to connect to our own patients outside of clinics without the potential exposure to COVID-19. When providing care to a new patient, I’d encourage seeking consent for the appointment summary to be sent to their regular doctor, who will add it to their medical records.
This is particularly important for people living with chronic conditions. Extensive research highlights the benefits of telehealth for people with chronic conditions, as well as parents with young children and caregivers of elderly patients. Although the focus is currently about supporting patients to screen and test for COVID-19, it’s important to remember that nearly 50% of GP visits are for the management of chronic disease and those people require ongoing support during this time.
The effective delivery of the telehealth expansion will require all of us in primary care to continue to adapt to the ever-changing landscape. In our collective effort to ensure high quality medical care is available to all in Australia, whether in person or online, we must remain committed to best practice and make sure online consultations continue to be implemented in a safe and appropriate way.
Dr Meena Qidwai is a medical practice owner with 14 years’ experience as a GP. Dr Qidwai is also Clinical Expert at Medinet Australia, providing after-hours support for patients on the Medinet app. Dr Qidwai is passionate about maintaining an individualised and holistic approach to patient care.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.