Feby Savira|Eva Yuen|Anna Ugalde|Katherine Young Graham|Anna Peeters
Long telephone consultations for<scp>GP</scp>appointments: evidence versus policy
Deakin University|Czech Academy of Sciences, Economics Institute|Deakin University|Deakin University|Health Net|Deakin University
strategies reduce barriers video consultations australia needs long telephone consultations coronavirus disease 2019 covid19 pandemic drove expansion telehealth subsidisation march 2020 october 2022 99 million standard general practitioner consultations delivered via telehealth1 medicare benefits schedule mbs gp telehealth items initially introduced temporary measures facilitate remote delivery care reduce transmission covid19 community telehealth consultations telephone based 3 video based federal government announced continued expiry medicare rebate long 20 minutes mbs telephone items 1 july 2022 means patients require long telephone consultations must switch video consultations travel see gp person selffund long telephone consultations note long telephone consultations still available patients seeking advice covid19 antivirals 31 december 2022 living remote remote areas2 context pandemic shifts reexamination mbs items appropriate changes based available evidence evidence underpins removal mbs items telephone consultations longer 20 minutes unclear indirectly suggests patients require long telehealth consultations achieve better outcomes video consultations qualitative data community health centres united states suggest video consultations several advantages including ability obtain visual cues eg patients social support living conditions enable better rapport building patient provider3 systematic review eight studies conducted covid19 pandemic encompassing acute homebased specialised care also found video consultation superior terms diagnostic decisionmaking accuracy compared telephone consultation4 however quality consultation telephone video consultations rated similarly patients types health problems addressed modalities similar found primary care speciality care research conducted pandemic5 6 2021 study st vincents hospital melbourne also showed difference emergency related outcomes video telephone consultations cardiology visits7 notably despite positive feedback video consultations gps identified limited utility video compared telephone facetoface consultations8 evidence needed compare telephone video consultations context primary care although clinicians united kingdom acknowledged benefits video consultations uptake low compared telephone consultations3 9 uptake gps australia similarly low10 11 indeed major caveat video consultations complex setup process3 7 12 recent qualitative study found australian gps preferred telephone consultations simpler medicare rebate video consultations10 however lack evidence inform appropriate reimbursement different telehealth modalities another study reported gps preferred photograph plus telephone consultations video consultations specific issues required visual assessment minimise technological delays8 us uptake video consultations primary speciality care predominantly driven practice clinician factors telehealth infrastructure clinician preference biases regarding ability willingness conduct video consultations12 telephone consultations may allow greater privacy3 vulnerable patients also likely use telephone consultations3 7 12 indeed older adults minority groups nonmetropolitan areas individuals low incomes less likely access internet digital devices poorer digital literacy13 14 factors together contribute disparities access health care particular among vulnerable groups experience barriers accessing facetoface care limited digital literacy access overall removal telephone consultations potentially disadvantages groups patients tend higher health care needs rural regional areas facing socioeconomic disadvantage older australians minority priority groups13 14 groups also likely lower capacity access video consultations reduced digital health literacy access digital technologies high costs digital technologies data13 14 analysed utilisation gp telephone consultations longer 20 minutes using data 140 regional primary care practices western victoria15 difference utilisation mbs items telephone consultations longer 20 minutes across various geographical characteristics box 1 immediate increase telehealth expansion policy introduced march 2020 lockdowns utilisation declined since august 2020 tapered around 10 gp consultations june 2021 findings suggest long telephone consultations still used region yet insufficient evidence long video consultations appropriate alternative monthly utilisation data analysed using generalised linear mixed models data provided statistical area level 2 sa2 comprising 60 sa2 areas within western victorian region data represent mean utilisation 95 confidence intervals statistical significance interaction month set p 005 factors lockdown periods follow pandemic rulings regional victoria rurality sa2 area matched corresponding modified monash model classification mm1 metropolitan mm2 regional centres mm3 large rural towns mm4 medium rural towns mm5 small rural towns socioeconomic status sa2 area derived index relative advantage disadvantage quintiles 12 represent areas higher socioeconomic disadvantage quintiles 35 represent areas lower socioeconomic disadvantage analysis gp video consultations longer 20 minutes tells different story high uptake video consultations onset covid19 areas higher socioeconomic advantage located closer urban centres box 2 data indicate barrier increasing uptake videobased items socioeconomically geographically disadvantaged areas june 2021 use video consultations longer 20 minutes minimal 02 gp consultations together data support continued expiry medicare rebate telephone items consultations longer 20 minutes present particularly absence significant investment resources time improving video uptake disadvantaged areas monthly utilisation data analysed using generalised linear mixed models data provided statistical area level 2 sa2 comprising 60 sa2 areas within western victorian region data represent mean utilisation 95 confidence intervals statistical significance interaction month set p 0001 factors lockdown periods follow pandemic rulings regional victoria rurality sa2 area matched corresponding modified monash model classification mm1 metropolitan mm2 regional centres mm3 large rural towns mm4 medium rural towns mm5 small rural towns socioeconomic status sa2 area derived index relative advantage disadvantage quintiles 12 represent areas higher socioeconomic disadvantage quintiles 35 represent areas lower socioeconomic disadvantage long telephone consultations remain available remote remote towns modified monash model classification mm67 many medium small rural towns mm45 classified areas limited internet mobile telephone service infrastructure would enable video calling capability many rural remote areas also higher proportions older people may reduced digital literacy increased barriers accessing facetoface care pandemic many older people chose cancel facetoface appointments complex medical vulnerabilities still required care increased cost travel facetoface appointments creates situation reduced health care equity socioeconomically geographically disadvantaged suggest need examination long telephone consultations australiawide gain fuller picture risks benefits long telephone consultations various contexts long telephone consultations critical supporting australians receive health care need rather reducing availability mbs telephone items consultations longer 20 minutes remote regions covid19 antiviral issues need recognise evidence substantial use mbs item little evidence support change including consideration potential problems overservicing adverse health experience outcomes different contexts understanding patient gp perspectives optimal consultation lengths critical inform evolution mbs item numbers feby savira supported alfred deakin postdoctoral research fellowship deakin university eva yuen supported executive dean health research fellowship deakin university anna ugalde supported victorian cancer agency midcareer research fellowship anna peeters supported national health medical research council investigator grant fellowship study funded western alliance funders role planning writing publication work thank western victoria primary health network intellectual input open access publishing facilitated deakin university part wiley deakin university agreement via council australian university librarians relevant disclosures commissioned externally peer reviewed