The impact of telehealth policy changes on general practitioner consultation activity in Australia: a time-series analysis
Keshia R. De Guzman
A B * , Centaine L. Snoswell A B and Anthony C. Smith A B C
A Centre for Online Health, The University of Queensland, Qld, Australia.
B Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia.
C Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark.
Australian Health Review 46(5) 605-612 https://doi.org/10.1071/AH22058
Submitted: 14 March 2022 Accepted: 21 July 2022 Published: 11 August 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY).
Abstract
Objective To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021.
Methods An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes.
Results After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant.
Conclusions The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services.
Keywords: COVID-19, general practice, general practitioner, pandemic, policy, primary care, telehealth, telemedicine.
References
[1] Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020; 26 309–313.| Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19).Crossref | GoogleScholarGoogle Scholar |
[2] Thomas EE, Haydon HM, Mehrotra A, et al. Building on the momentum: Sustaining telehealth beyond COVID-19. J Telemed Telecare 2020; 28 301–308.
| Building on the momentum: Sustaining telehealth beyond COVID-19.Crossref | GoogleScholarGoogle Scholar |
[3] Snoswell CL, Caffery LJ, Haydon HM, et al. Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic. Aust Health Rev 2020; 44 737–740.
| Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic.Crossref | GoogleScholarGoogle Scholar |
[4] Wright M, Versteeg R, Hall J. General practice’s early response to the COVID-19 pandemic. Aust Health Rev 2020; 44 733–736.
| General practice’s early response to the COVID-19 pandemic.Crossref | GoogleScholarGoogle Scholar |
[5] Jonnagaddala J, Godinho MA, Liaw S-T. From telehealth to virtual primary care in Australia? A Rapid scoping review. Int J Med Inform 2021; 151 104470
| From telehealth to virtual primary care in Australia? A Rapid scoping review.Crossref | GoogleScholarGoogle Scholar |
[6] Snoswell CL, Caffery LJ, Taylor ML, et al. Telehealth and coronavirus: Medicare Benefits Schedule (MBS) activity in Australia. Centre for Online Health, The University of Queensland; 2021. Available at https://coh.centre.uq.edu.au/telehealth-and-coronavirus-medicare-benefits-schedule-mbs-activity-australia [accessed 4 February 2022]
[7] De Guzman KR, Snoswell CL, Caffery LJ, et al. Economic evaluations of videoconference and telephone consultations in primary care: A systematic review. J Telemed Telecare 2021; 1357633X211043380
| Economic evaluations of videoconference and telephone consultations in primary care: A systematic review.Crossref | GoogleScholarGoogle Scholar |
[8] Australian Government Department of Health. MBS Telehealth Services from January 2022. 2022. Available at http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Telehealth-Arrangements-Jan22 [accessed 4 February 2022]
[9] De Guzman KR, Caffery LJ, Smith AC, et al. Specialist consultation activity and costs in Australia: Before and after the introduction of COVID-19 telehealth funding. J Telemed Telecare 2021; 27 609–614.
| Specialist consultation activity and costs in Australia: Before and after the introduction of COVID-19 telehealth funding.Crossref | GoogleScholarGoogle Scholar |
[10] The Royal Australian College of General Practitioners (RACGP). Changes to MBS telehealth items from 1 July 2021. 2021. Available at https://www.racgp.org.au/running-a-practice/practice-resources/medicare/medicare-benefits-schedule/changes-to-mbs-telehealth-items [accessed 4 February 2022]
[11] De Guzman KR, Snoswell CL, Giles CM, et al. GP perceptions of telehealth services in Australia: a qualitative study. BJGP Open 2022; 6 BJGPO.2021.0182
| GP perceptions of telehealth services in Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[12] Willcock SM, Cartmill JA, Tse T, et al. How will telehealth change primary care in Australia? BJGP Open 2022; 6 BJGPO.2021.0186
| How will telehealth change primary care in Australia?Crossref | GoogleScholarGoogle Scholar |
[13] Sturmberg JP, O’Halloran DM, McDonnell G, et al. General practice work and workforce: Interdependencies between demand, supply and quality. Aust J Gen Pract 2018; 47 507–513.
| General practice work and workforce: Interdependencies between demand, supply and quality.Crossref | GoogleScholarGoogle Scholar |
[14] Australian Government. Medicare Item Reports. 2021. Available at http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp [accessed 4 February 2022]
[15] Mehrotra A, Bhatia RS, Snoswell CL. Paying for Telemedicine After the Pandemic. JAMA 2021; 325 431–432.
| Paying for Telemedicine After the Pandemic.Crossref | GoogleScholarGoogle Scholar |
[16] Joshi AU, Lewiss RE. Telehealth in the time of COVID-19. Emerg Med J 2020; 37 637–638.
| Telehealth in the time of COVID-19.Crossref | GoogleScholarGoogle Scholar |
[17] Fisk M, Livingstone A, Pit SW. Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States. J Med Internet Res 2020; 22 e19264
| Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States.Crossref | GoogleScholarGoogle Scholar |
[18] Johnson C, Dupuis JB, Goguen P, et al. Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic. PLoS One 2021; 16 e0258839
| Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic.Crossref | GoogleScholarGoogle Scholar |
[19] Breton M, Deville-Stoetzel N, Gaboury I, et al. Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic. Healthc Policy 2021; 17 73–90.
| Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic.Crossref | GoogleScholarGoogle Scholar |
[20] Jetty A, Jabbarpour Y, Westfall M, et al. Capacity of Primary Care to Deliver Telehealth in the United States. J Am Board Fam Med 2021; 34 S48–S54.
| Capacity of Primary Care to Deliver Telehealth in the United States.Crossref | GoogleScholarGoogle Scholar |
[21] Chudner I, Drach-Zahavy A, Karkabi K. Choosing Video Instead of In-Clinic Consultations in Primary Care in Israel: Discrete Choice Experiment Among Key Stakeholders-Patients, Primary Care Physicians, and Policy Makers. Value Health 2019; 22 1187–1196.
| Choosing Video Instead of In-Clinic Consultations in Primary Care in Israel: Discrete Choice Experiment Among Key Stakeholders-Patients, Primary Care Physicians, and Policy Makers.Crossref | GoogleScholarGoogle Scholar |
[22] Hammersley V, Donaghy E, Parker R, et al. Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care. Br J Gen Pract 2019; 69 e595–e604.
| Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care.Crossref | GoogleScholarGoogle Scholar |
[23] Downes MJ, Mervin MC, Byrnes JM, et al. Telephone consultations for general practice: a systematic review. Syst Rev 2017; 6 128
| Telephone consultations for general practice: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[24] Seuren LM, Wherton J, Greenhalgh T, Cameron D, A’Court C, Shaw SE. Physical examinations via video for patients with heart failure: Qualitative Study Using Conversation Analysis. J Med Internet Res 2020; 22 e16694
| Physical examinations via video for patients with heart failure: Qualitative Study Using Conversation Analysis.Crossref | GoogleScholarGoogle Scholar |
[25] Wherton J, Shaw S, Papoutsi C, Seuren L, Greenhalgh T. Guidance on the introduction and use of video consultations during COVID-19: important lessons from qualitative research. Transl Res Evid 2020; 4 120–123.
| Guidance on the introduction and use of video consultations during COVID-19: important lessons from qualitative research.Crossref | GoogleScholarGoogle Scholar |
[26] 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 Remote Health 2016; 16 3808
| Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability.Crossref | GoogleScholarGoogle Scholar |
[27] Moffatt JJ, Eley DS. The reported benefits of telehealth for rural Australians. Aust Health Rev 2010; 34 276–281.
| The reported benefits of telehealth for rural Australians.Crossref | GoogleScholarGoogle Scholar |
[28] Snoswell CL, Stringer H, Taylor ML, et al. An overview of the effect of telehealth on mortality: A systematic review of meta-analyses. J Telemed Telecare 2021;
| An overview of the effect of telehealth on mortality: A systematic review of meta-analyses.Crossref | GoogleScholarGoogle Scholar |
[29] Snoswell CL, Chelberg G, De Guzman KR, et al. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2021;
| The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019.Crossref | GoogleScholarGoogle Scholar |
[30] Graetz I, Huang J, Muelly E, et al. Primary Care Visits Are Timelier When Patients Choose Telemedicine: A Cross-Sectional Observational Study. Telemed e-Health 2022;
| Primary Care Visits Are Timelier When Patients Choose Telemedicine: A Cross-Sectional Observational Study.Crossref | GoogleScholarGoogle Scholar |
