COVID-19 and Rural Healthcare Access
Is this an opportunity for improved health access for regional and rural Australians?
As we start to contemplate life post COVID-19 there may be opportunities to make the innovative tools of digital health an integral part of our health system.
One third of Australians live in rural and remote locations. Reports from the Australian Bureau of Statistics state that people living outside major cities in Australia are more likely to have long-term health conditions including arthritis, asthma, back problems, deafness, long-sightedness, diabetes, heart disease, stroke and vascular disease. Allied health and nursing practitioners have a significant role to play in managing these and other health conditions. Evidence has shown that there are increased adverse health outcomes for every 5 km away a person lives from the metropolitan centre and there are many specialist services that only offer limited services outside metropolitan regions. For example only 1% of haematologists in Victoria practise outside of metropolitan areas.
Although many rural health practitioners have known the benefits of telehealth, integration of telehealth into mainstream practice has been slow and fragmented. The use of telehealth for allied health professions enables:
- Similar outcomes in terms of chronic disease management for patients
- Improved access to services to reduce the risk of comorbidities and complications
- Reduced travel cost, time and inconvenience for patients
- Opportunities for new models of coordinated care in rural areas.
The barriers and challenges associated with telehealth in Australia have been well described. These include clinician preference for face-to-face consultations, ethico-legal concerns, change in management practices, resources (including time), funding models, service coordination challenges and additional training for administration personnel. Funding opportunities for general medical and allied health practitioners telehealth services have been very limited or non-existent, as are funding opportunities for the required store-and-forward telehealth applications. The COVID-19 pandemic has demonstrated to resistant practitioners how effective telehealth can be for a wide range of consultations in the rural and remote context and the federal government has acknowledged and acted upon the need for radical change to the Medicare Benefit Schedule (see Department of Health resources section for more information).
Technology is constantly improving with barriers such as imaging quality and poor connectivity being addressed. Numerous platforms can be used and apps are constantly being developed. There are assessment tools and therapy tools that are available for many allied health professions, some of which previously would not have been thought of as possible. Health professionals have the advantage when using real time monitoring apps in that they can monitor the client’s adherence to, for example, exercise regimes and can follow up on the reasons why they may be struggling. It can also give the clinician an insight into the client’s home environment and possible issues that may need intervention.
There has been a preconceived idea that older Australians struggle with technology, but health professionals have commented that this generally hasn’t been the case. In fact many are quite savvy with technology.
Telehealth can enable an easier platform for teachers, aids, interpreters, allied health assistants and carers to be involved with a client’s care. There can be “real time assessment” occurring.
There have been numerous training webinars on the uses of digital health, and much discussion has occurred about the challenges and the solutions to these challenges.
The Australian Digital Health Agency (ADHA) recognises that this forced rapid adoption of digital health services has presented some challenges, but notes that it has also created opportunities. ADHA are looking for digital health solutions that will enable delivery of care in new ways, improve health outcomes, strengthen responses to health emergencies and accelerate digital health. Funding grants of up to $50,000 are available. See https://innovation.digitalhealth.gov.au/ for details.
Information and resources that are available for telehealth:
Please see below information (link and summary) from the Department of Health re the last updated MBS factsheet dated 20th April:
- From 13 March 2020 to 30 September 2020 (inclusive), new temporary MBS telehealth items have been made available to help reduce the risk of community transmission of COVID-19 and provide protection for patients and health care providers.
- The list of telehealth services has continued to expand since 13 March. This is the latest factsheet and provides details on all current telehealth items.
- The new temporary MBS telehealth items are available to GPs, medical practitioners, nurse practitioners, participating midwives and allied health providers.
- A service may only be provided by telehealth where it is safe and clinically appropriate to do so.
- The new temporary MBS telehealth items are for non-admitted patients.
- It is a legislative requirement that the new telehealth services, where they are provided by GPs and Other Medical Practitioners (OMP), must be bulk billed for Commonwealth concession card holders, children under 16 years old and patients who are more vulnerable to COVID-19.
- As of 20 April 2020, specialist and allied health service providers are no longer required to bulk bill these new telehealth items.
- Providers are expected to obtain informed financial consent from patients prior to providing the service; providing details regarding their fees, including any out-of-pocket costs.
- The bulk-billing incentive Medicare fees have temporarily doubled (until 30 September) for items relating to GP and OMP services, diagnostic imaging services (items 64990 and 64991) and pathology services (items 74990 and 74990). These items can be claimed with the telehealth items where appropriate. The fees are provided later in the factsheet. As of 20 April, two new bulk-billing incentive items have been introduced for services provided to patients who are more vulnerable to COVID-19.
- Comparison of VC platforms https://coh.centre.uq.edu.au/quick-guides-telehealth
- Collated resources for use by professionals to provide rehabilitation via telehealth. Source: Stroke Foundation (Australia) – https://informme.org.au/en/News/2020/03/26/COVID-19-Telehealth-resources
- Tips for doing Social Work remotely including virtual meetings and other resources. Source: various contributors https://padlet.com/kenneth28burns/uvpu626mvd5k
- Murray PHN https://www.murrayphn.org.au/covid19resources/
- WestVic PHN https://westvicphn.com.au/covid-19-response/
- Telehealth – Embracing technology in healthcare – This course is designed to facilitate learning and understanding about telehealth services so clinicians can begin to include it in their provision of healthcare and learn more about best practice in telehealth service delivery. Further information on the course content can be located at Three Rivers Telehealth
- https://ahpa.com.au/resources/ – digital health
Australian Bureau of Statistics. 4102.0 – Australian Social Trends, 2008. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter3002008
ABS (Australian Bureau of Statistics) 2015. National Health Survey: First Results, 2014–15. ABS cat. no. 4364.0.55.001. Canberra: ABS.
Bradford NK, Caffery LJ, Smith AC. Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability. Rural and Remote Health 2016; 16: 3808. (Online) Available: http://www.rrh.org.au
Moffatt JJ, Eley DS. Barriers to the up-take of telemedicine in Australia – a view from providers. Rural and Remote Health (Internet) 2011; 11(2): 1581. Available: www.rrh.org.au
Department of Health website – factsheets & resources: https://www.health.gov.au
Going Rural Health, in response to COVID-19, are facilitating virtual placements for tertiary health students. Placement co-ordinators are working with stakeholders to ensure curriculum needs and responsibilities re privacy are met and upheld. Telehealth platforms are being utilised, which is mirroring what is happening in the sector, and the student receives supervision via virtual platforms.
We need to keep this momentum of innovation and opportunity. Collaborative information sharing and education between all health providers as this acceleration of digital health continues will be of significant benefit for the health outcomes of rural and regional communities across Australia.
Going Rural Health Education Co-ordinator