MY OWN review of Medicare data for GP services for the period 1 April 2020 to 31 March 2021 highlights some interesting trends in the use of video for GP telehealth consultations.
The Australian Government paid $49.5 million in Medicare benefits for Australian GP video telehealth services conducted in the period 1 April 2020 to 31 March 2021. It paid $1.8 billion in Medicare benefits for Australian GP phone services in the same period. For every Medicare dollar spent on video telehealth services, 36 Medicare dollars were spent on phone services.
In the same 12-month period, there were 149 213 674 GP services – 72.0% were in-person, 27.4% were by phone, 0.6% were by video, 97.7% of GP telehealth services were by phone, and 2.3% of GP telehealth services were by video. Video was used for 0.6% of Level A, B, C and D attendances; for 0.6% of chronic disease management items; and for 1.4% of mental health items.
The Medicare Benefits Schedule (MBS) states “videoconference services are the preferred approach for substituting a face-to-face consultation. However, in response to the COVID-19 pandemic, providers will also be able to offer audio-only services via telephone if video is not available”.
It seems that video was not used in 97.7% of GP telehealth consultations. This begs the question of whether video was not available for whatever technical reason, or was simply not preferred by either the doctor or the patient.
Compare those numbers with the following data on the telehealth consultations by consultant physicians, non-GP specialists and mental health clinicians. The source of these data is the University of Queensland Centre for Online Health, which analyses and summarises MBS service data on a monthly basis.
In March 2021, 12% of consultations by consultant physicians and non-GP specialists (excluding psychiatrists) were by telehealth – 78% were by phone and 22% by video.
In the same month, 32% of consultations by psychiatrists were by telehealth – 49% were by phone and 51% by video.
In the same month, 18% of mental health services by psychologists, clinical psychologists, social workers, and GPs were by telehealth – 50% were by phone and 50% by video.
What is clear to me is that, with the possible exception of mental health consultations, video is underutilised by Australian GPs for telehealth services.
So, what does the evidence say about the use of video telehealth in general practice? Despite considerable literature on telehealth generally, there is limited evidence about its use in general practice globally and very limited evidence on video telehealth in Australian general practice.
A scoping review by Jonnagaddala and colleagues in 2021 reported that the COVID-19 pandemic has highlighted challenges in literacy, maturity, readiness and organisation in adapting telehealth to support integrated person-centred health care. They concluded that there is a need for more research into how telehealth can improve the access, integration, safety and quality of virtual primary care.
Thomas and colleagues (2020) highlighted five key requirements for long term sustainability of telehealth: developing a skilled workforce, empowering consumers, reforming funding, improving digital ecosystems, and integrating telehealth into routine care.
The most relevant overseas evidence is from the summary of the evaluation report by University of Oxford on the Near Me video consulting service for health care and social care in Scotland. Near Me uses the “Attend Anywhere” video platform, which has similar functionality to Australia’s “Healthdirect Video Call”. Near Me was introduced in 2018 and the rollout was accelerated in 2020 in response to the COVID-19 pandemic.
According to the evaluation, most patients, members of the public, and clinicians perceived video consulting as beneficial, both during the pandemic and longer term. Patient surveys showed positive outcomes in patient satisfaction. Quality of the video call had a significant impact on patient-reported outcomes. Problems with internet connectivity, digital access, and privacy in the patient’s home were highlighted as negative features of video consulting.
Approximately two-thirds of Scottish general practices used Near Me during the COVID-19 pandemic lockdown. This decreased to approximately one-third when lockdown restrictions were eased. GPs recognised the value of video consulting. They also described problems accessing video call technology and information technology support.
A systematic review from Canada in 2018 reported that video telehealth resulted in fewer medication errors, greater decision-making accuracy, and greater diagnostic accuracy compared with phone telehealth. There were no consistent differences between video and phone for patient outcomes and patient satisfaction. The authors concluded that the sample was small and that the findings could not be generalised. They recommended more research to determine the circumstances under which video is superior to phone as a telehealth modality.
Donaghy and colleagues (UK, 2019) reported that the visual component of video consultations offers distinct advantages over telephone consultations. They noted that demand for video consultations in primary care is likely to rise, but that improved technical infrastructure is necessary to enable video consultations to become routine.
Seuren and colleagues (UK, 2021) describe the importance of trust in video consultations. Patients and clinicians must be able to trust the technology, trust one another’s capability to use the technology, and use the technology to build and maintain a therapeutic relationship.
Norwegian GPs expect that they will conduct 20% of their consultations by video in a future non-pandemic setting.
The key points in the literature about video telehealth can be summarised as follows:
- video telehealth is acceptable to health professionals and patients;
- health professionals and patients have a strong interest in video telehealth during and after the COVID-19 pandemic;
- outcomes of video telehealth consultations and in-person consultations may be equivalent;
- there may be access inequality favouring younger and more technologically literate patients;
- limitations include problems with internet connection, equipment, and telehealth workflows;
- there are complex challenges in embedding video telehealth in organisations that are hesitant to change;
- there is a need for more research into video telehealth to determine its role, health care outcomes, safety, efficacy and cost-effectiveness; and
- there is a need for education for health professionals and support for patients in using video telehealth.
This analysis of Medicare data and the literature review raise questions about telehealth in Australian general practice.
- Are patients getting good care?
- Is Medicare getting value for money?
- What are the barriers to video telehealth for GPs and for patients?
The proportion of telehealth services provided by video is higher for non-GP specialists and other health care practitioners than for GPs. Video telehealth is clearly underused in Australian general practice. GPs should consider putting the phone down and turning their webcam on.
Dr Andrew Baird is a GP at the Elwood Family Clinic in Victoria. He is a tutor in professional practice for medical students at the University of Melbourne.
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.