A survey of chronic care patients has found more than half delayed a healthcare appointment or test in the past three months, with some believing it would be in breach of lockdown rules
A survey of chronic care patients has found more than half delayed a healthcare appointment or test in the past three months, with some believing it would be in breach of lockdown rules.
The Continuity of Care Collaboration, a group of around 30 health organisations set up in response to the drop in attendances during COVID-19, surveyed 729 people during May about their access to care during the pandemic – 89% were patients with at least one chronic condition and the remainder were carers.
Fifty-two per cent said they’d delayed or avoided an appointment, most commonly a GP visit (32%), an allied health visit (22%) or a pathology test (21%).
Among the reasons checked for missing appointments were anxiety about taking public transport (36%) and that attending a non-COVID-19 health appointment would be breaking lockdown rules (23%), which was never the case.
Half said it would take an emergency for them to seek face-to-face help, and 55% said it was safe to delay regular appointments if nothing had changed and they felt fine.
More than 40% said they preferred to have their usual appointments over telehealth, but more than a quarter said it posed technological or access difficulties. Women were more likely than men (47%-34%) to prefer telehealth.
CCC member organisations are reporting signs, not captured by the survey, that the decline is reversing. According to the Royal College of Pathologists of Australia pathology tests had dropped by about 40% but were now only 10-20% below average, and Allied Health Professions Australia CEO Claire Hewat said patients were returning to in-person appointments.
RACGP president Dr Harry Nespolon said the situation had improved now that the acute phase had passed.
He said the constantly changing instructions around what people were allowed to do had been a problem.
“We were getting different messages from different levels of government,” Dr Nespolon said. “People were told you can go to your GP, but we were also ‘scaring’ people about the dangers of leaving self-isolation, especially at-risk and vulnerable patients such as those with chronic conditions.
“So people did the right thing, they protected themselves and put anything they thought was discretionary on hold.”
GPs had also not wanted potential COVID-19 cases to come to their practices and had to work out how to handle patients.
“We realised a bit late in the day that there’d been this drop-off,” he said. “It’s much better now, we have systems in place, and people understand the risk is now low.”
According to a TMR survey of 174 GPs and practice managers, about 85% had lost revenue in March and April compared with last year, and about a third had lost at least 30% of revenue.
This is in spite of a TMR analysis of Medicare data showing that overall GP billings were up about 16% in April compared with last April, with the drop in regular attendances more than made up by telehealth billings. This suggests practices have missed out enormously if they weren’t on top of the technology.
Dr Nespolon said Health Minister Greg Hunt was enthusiastic about keeping telehealth as part of Medicare past the sunset date of September 30, but there needed to be some constraints to ensure it was used in the best way for patients. That was not as simple as it sounded.
“There needs to be a connection between the telehealth providers and face-to-face consultations – we’ve been saying that since day one,” he said. “It works better if the doctor knows the patient; you can make better decisions about telehealth if you’ve got some history.
“You can’t run your medical practice out of a Melbourne call centre and expect to provide good care for a patient in Cairns.
“But we’re a mobile society: how do you deal with a new patient in your area? The detail matters in all of this. There are different ideas about it, and they all have merit and they all have problems.”
He said 20-30% of people at any time had not had a consult in the past 12 months, so the original rule – that a patient must have seen that practitioner in the past year before accessing telehealth rebates – excluded a large chunk of the population.
“So after that it was open slather, and that was the right thing to do,” Dr Nespolon said. “But after September 30 we have to look at non-urgent situations.
“What we want to see is traditional general practice supported and not just a proliferation of telehealth pop-ups that cherry-pick the easy consults – we can’t have an Edelstenisation of telehealth.
“It leaves the most invested and committed GPs having the rug pulled out from under them. It’s even worse in rural areas. If you’ve got a Melbourne call centre taking all the easy stuff, it makes those rural practices even more marginal.”
For a call centre to be viable, it couldn’t be restricted to one geographical area; but to service the entire country and have agreements with local GPs everywhere would require thousands of contracts.
An option for the call centre model was to run privately and just not bill Medicare, he said.
“This is an opportunity for change, to deliver better healthcare and take advantage of new technologies,” he said. “But it needs to be an Australian system, not one we pull off the shelf from overseas.”
