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Wednesday, April 14, 2021

Telehealth rollbacks to affect remote communities, the vulnerable and sexual health

Health care organisations have expressed fears the Federal Government’s decision to restrict Telehealth appointments to existing patient/doctor relationships will further exacerbate the access to services gap between major cities, regional cities and rural and remote towns.

They also believe it will disproportionately affect women seeking one-off sexual health services and socially vulnerable people making initial contact with the health system via telephone.

Federal Health Minister, Greg Hunt, said his decision to limit Telehealth services to patients who have seen the practitioner for a face-to-face consultation in the last 12 months was based on recommendations from the Australian Medical Association (AMA) and the Royal College of General Practitioners for the purpose of “better quality” care.

“This will ensure patients continue to receive quality, ongoing care from a GP who knows their medical history and needs,” Mr Hunt said.

People under the age of 12 months, people experiencing homelessness and Victorians living under stage three lockdown will be exempt.

The rollback has surprised some health advocates, who have argued for full Telehealth delivery to be extended beyond the COVID-19 health crisis and to be considered an essential part of the ‘new normal’.

A Canberra Health Services spokeswoman said Telehealth had been fundamental in linking specialist medical support to patients who cannot travel to the hospital for their appointments or patients who are simply worried about leaving home. However, sustained use of the Telehealth service was dependent on the Commonwealth’s decision to fund the program beyond the pandemic.

“Clinicians and patients have been very positive about the service and Canberra Health Services is exploring options for extending Telehealth services in other models of care to offer more efficiencies in the system to deliver high quality care,” the spokeswoman said.

Telehealth has been broadly embraced by advocates of carers and people with disabilities; Carers ACT has implemented a Telehealth Support Program to assist members of the community to access appointments by providing technical support to patients before and during the appointment. This includes providing resources and support for people who may not have a computer at home, or who are not confident in using the technology.

Canberra Health Services is also finalising arrangements for an interpreter service to support Telehealth video appointments to expand the opportunity to the culturally and linguistically diverse population.

ACT Health Minister Rachel Stephen-Smith said she understood the Commonwealth sought to restrict access to Telehealth in order to prevent “pop-up” providers taking advantage of the program without providing quality care for patients. However, she had “significant concerns” about the implementation and unintended consequences for long-standing specialist primary care providers.

“I have written to Minister Hunt on behalf of Sexual Health and Family Planning ACT and other established providers that may not have ongoing relationships with patients, but provide either specialist services or inclusive services for vulnerable people who may reach out for an initial appointment via Telehealth,” she said.

Marie Stopes Managing Director, Jamal Hakim, said they were given six days’ notice to prepare for the changes to Medicare.

“To remove support for sexual and reproductive healthcare providers across the country at a time like this is beyond belief,” he said.

“Established Telehealth provision of sexual and reproductive health is safe; it works and it’s cheaper.”

Marie Stopes CEO Alexis Apostolellis said the rollbacks were “particularly concerning” for time-critical services such as Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis for HIV prevention.

“We don’t want sexual and reproductive health services to become harder to access for the people who need them most, including women and LGBTIQ communities,” he said.

“We need to ensure patients can still access sexual or reproductive health services when they need to.”

National Rural Health Alliance CEO, Dr Gabrielle O’Kane, said Telehealth services were incredibly important for people in rural and remote communities who often have limited access to face-to-face appointments because of travel times or a shortage of the local health workforce and “flexibility and common sense” were essential.

“We broadly welcome the Australian Government’s decision to ensure that GP Telehealth providers have a continuous relationship with a patient because this will help protect these practices in rural and remote areas and ensure they offer face-to-face care when it is needed,” she said.

“It’s important though that this move doesn’t end up restricting health access even further for rural and remote consumers – such as when they have just moved to a new area and don’t have an existing relationship with a GP.

“We will continue to listen to rural consumers and providers and take their concerns to the government.”

Shadow Minister for Health, Chris Bowen, said Labor supported an extension of Telehealth beyond September. 

“We recognise that Telehealth subsidies for existing patient and doctor relationships will lead to best health outcomes, but we also acknowledge that if you are vulnerable, disabled, or live in regional and rural Australia it is harder to see a doctor. 

“Labor supports the intent of this amendment to support better health outcomes and to stop lower quality corporate health care companies monopolising the Telehealth market – but this ruling cannot be at the cost of the health of our vulnerable, regional and rural Australians. The government must consider the needs of these Australians in a Telehealth extension.”

AMA ACT president, Dr Antonio Di Dio, said while fractured health care was disastrous for vulnerable patients, restricting patients to their regular GP would help avoid that.

“We have supported Telehealth for a long time, but we need to allow people to get continuity of care,” he said.

“We need to have special provisions for vulnerable people to apply to get access to Telehealth.”

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