Since 2020, telehealth has given patients greater flexibility and improved access to healthcare. As phone and video consultations become an increasingly popular tool for burdened medical services, it’s time to take a transparent look at the benefits and drawbacks of non-traditional medical appointments.

How COVID Changed Doctor Appointments

The Australian government rapidly expanded access to Medicare-subsidised telehealth services in 2020, to meet COVID-19 health protocols. Supplemented further by electronic prescribing services, telehealth appointments eliminated travel time and associated costs for patients, while providing all the convenience of a doctor home visit, without the significant call-out fee or lengthy wait time.

On the clinical side, doctors could connect to patients regardless of their location; a doctor in Western Australia could support patients in inner-city Sydney, a patient in Broken Hill could connect with a doctor in Melbourne; GPs have been able to meet patient demand, wherever that demand was located. Doctors have been able to take on more appointments thanks to telehealth; Remote working reduces commute times for clinicians and increases their ‘clinic hours’, while clinics have been able to allocate appointments without being limited by available consulting rooms.

In 2019, 0.2% of all Australian medical appointments were conducted via telehealth. Between April and December 2020, approximately 37% of all consultations performed in Australia were via phone or video consultation. While the surge seen in the COVID years has tapered off, over 25% of all Australians have had at least one telehealth medical appointment within the last 12 months.

Telehealth has proved a highly convenient option for many Australians. Supported by both the public and private sector, it has become a lasting part of our healthcare system.

Benefits of Telehealth

Healthcare Equity

As a country with a publicly funded health system, Australian health services are meant to be distributed fairly across local health districts. In reality, people in rural, regional, or low-income urban areas are more likely to face a lack of access to healthcare than their city-dwelling counterparts. They are much more likely to experience; longer wait times, fewer specialists and services in their region, limited access to diagnostic tools and treatments, and worse health outcomes, particularly for chronic disease and mental health.

Conversely, those in affluent or metropolitan areas often benefit from better infrastructure, more healthcare providers, and faster access to care.

The postcode lottery challenges the principle of equity in healthcare; that all individuals should receive high-quality care regardless of where they live. The Government aims to reduce these gaps through funding, rural workforce incentives, and digital health services like telehealth, to help bridge the divide.

Queensland: Early User Of Telehealth

Prior to COVID 19, Queensland led the charge in telehealth use, accounting for 40% of all Australian telehealth appointments. Until 2020, telehealth was mainly used to connect patients in the Queensland outback to distant specialists.

Before the pandemic, Queensland had the most extensive telehealth infrastructure, accounting for 40% of all telehealth services across Australia.
– Medical Journal of Australia, Beyond The Planned and Expected, 20 May 2024.

Support For Chronic Disease Patients

The rise in telehealth has been a turning point for patients with chronic diseases, providing significant reductions in costs and travel time for patients with regular, on-going maintenance appointments to manage their conditions. Telehealth also greatly reduces the risk of infection transmission.

In the largest study of its kind, the CSIRO conducted a trial review into home-monitoring of chronic diseases via telehealth. While targeting older chronic disease patients, the results highlighted multiple beneficial outcomes. Patients reported improvements in anxiety, depression and quality of life, many found home monitoring gave them a better understanding of their conditions. The trial also showed a substantial 53% decrease in hospital admission, 76% reduction in length of stay if admitted, and a reduced mortality rate of more than 40 per cent.

Access For Mental Health Patients

While appointments for mental health professionals remain in high demand, telehealth access alleviates the burden on these services. Clinicians have also observed that vulnerable patients are naturally more hesistant to reach out for help – telehealth appointments allow these patients to seek support in the comfort of their own home, further removing obstacles to accessing mental health care. The Australian Psychological Society and other mental health bodies found that telehealth maintains clinical effectiveness, improves session attendance, and helps reduce barriers to care continuity for patients.

Minimises Burden on Hospitals

Multiple pilot programs and international studies have shown that telehealth significantly reduces hospital admissions and readmissions, particularly when used for chronic disease management or home-based acute care. While specific outcomes vary by condition and context, this trend supports telehealth as a valuable tool for easing hospital burden and improving outcomes.

Telehealth consultations are far more efficient clinically, especially for relatively simple cases. This frees up GPs for those face-face appointments that need to be longer in duration, require physical examination, or are simply more complex, benefitting the GP, but moreover – benefitting the patient.
– Dr Rohan Reddy, Total Veteran Healthcare GP, and Chief Medical Officer of Pain Management.

Here To Stay

The Australian Government recognises telehealth as a vital component of our health system and has made significant investment in its infrastructure. Telehealth has been permanently integrated into the Medicare Benefits Schedule since January 2022, and is an integral part of multiple government programs. These include Better Access; a national initiative providing access to mental health professionals and mental health care to Australians, regardless of their geographical location.

Telehealth and Veteran Healthcare

Telehealth appointments reduce the compounding costs associated with attending clinical appointments. For high use patients, these costs can become significant.

Veterans – High Use Patients

Veterans have significant medical touch points; 60% of Veterans live with a chronic health condition, and the DVA medical system requires a significant amount of medical diagnostics – a process where Veterans must engage with a suite of clinicians to determine the status of their overall health before they can completely access healthcare. Once this process is complete, treatment begins in earnest and patients engage with GPs, Allied Health professionals, and Specialists through government funding.

Research from the Department of Veterans Affairs indicates that Veterans receiving Allied Health services visit their GP an average of 14 times per year. Patients with Total Veteran Healthcare visit a member of their care team (either their GP, Allied Health, or Specialist clinician) around 12 times per year.

High Density Doesn’t Equal Medical Access

The majority of the Australia’s 581,139 Veterans live in “high density areas,” with a third residing in regional locations. However, high density does not necessarily equate to high medical access. For example, Queensland has the largest share of Veteran residents, with 28% living in the sunshine state. Veteran hotspots include Townsville (circa 15,000) the Gold Coast (circa 14,000), and Ipswich (circa 14,000).

Despite Townsville’s significant Veteran population, wait times for psychiatry appointments in Australia’s largest northern city are a reported 6-9 months. The area also experiences a reported lack of physiotherapists to serve the Veteran community. Further specialist clinics and services in escalation healthcare, like TMS, are also limited, with one TMS clinic serving the region. Compare this to centrally-located Ipswich, where wait times for psychiatry appointments are just four weeks.

By offering telehealth, Total Veteran Healthcare is able to provide experienced psychiatrists to Veterans all across Australia.

While services like TMS must be administered in person, telehealth provides much needed access to Veterans healthcare, regardless of postcode. This is particularly vital for specialist or nichè services, such as escalation treatments, or specialists with specific experience treating Veterans.

Increased Access To Veteran GPs

Australia is currently experiencing a shortage of GPs that is placing unprecedented pressure on the current health system. As Veterans tend to require more GP visits than the average person, the Veteran community feels this shortage more acutely.  

There is further shortage of GPs who specialise in Veteran healthcare, and a limited number of purpose-built, Veteran-focused GP clinics. Veteran patients benefit significantly from having a Veteran GP:

• Veteran GPs design informed treatment plans
• Veteran GPs provide better support for DVA Claims
• Veteran GPs are aware of escalation treatment options
• Veteran GPs have a better understanding of their patient’s service history.

Through phone and video appointments, Veteran GPs can support more patients in more locations, spreading the benefit of their expertise.

Drawbacks Of Telehealth-Only Services

Five years on from the COVID-19 pandemic, telehealth services and businesses have evolved dramatically. This increase has raised concerns about providers and patients overly reliant on phone appointments, particularly telehealth-only providers.

Limited Physical Examinations

Clinicians cannot perform a physical exam via telehealth, and there is a risk of some conditions being misdiagnosed or overlooked. Furthermore, clinicians are more reliant on a patient’s ability to fully disclose their health concerns. This increases the likelihood that a patient assumes a telehealth diagnosis is sufficient, delaying clinically appropriate treatment.

Potential For Fragmented Care

Same day prescription services and bulk-billing apps that use telehealth to connect to patients have surged since COVID-19. While they offer convenience, repeated use of one-off appointments with independent, telehealth-only providers can lead to fragmented medical care.

Your usual GP has a clear understanding of your complete medical history. While it’s not always possible to see your GP, repeated telehealth-only appointments can result in communication silos. This means that neither your usual GP, nor the telehealth provider, have an adequate understanding of your previous history or current medical needs. Fragmented care can result in misdiagnosis, medication errors, and delays to receiving correct treatment.

Telehealth and Pharmaceuticals

In 2020, the Federal Government expanded the Medicare Benefits Scheme to include telehealth services to support pre-existing telehealth services. In the years since, Australia has seen a significant increase in ‘pop-up’ telehealth-only providers. The RACGP has referred to these kinds of businesses as “DTC (Direct-To-Consumer) Opportunistic Telehealth Businesses”, and expressed concern about the potential of these providers to undermine the therapeutic relationship between a patient and their regular GP.

‘Many of these services aren’t staffed by GPs, they’re staffed by doctors who aren’t trained as specialist GPs, and as a consequence, many of these are business opportunities versus being healthcare providers,’ – Dr Nicole Higgins, RACGP President, speaking to newsGP.

Pop-up or single-issue telehealth providers often specialise in one area, such as medicinal cannabis, medical certificates, or weight loss. These providers have had significant impact on Veteran healthcare – particularly in the prescribing of Medicinal Cannabis. Medicinal Cannabis is a common escalation treatment, that is subject to firm regulations to ensure its safe and clinically appropriate use.

As highlighted by the ABC, there has been an influx of pharmaceutical companies using telehealth to sell products directly to patients. These arrangements included aggressive and misleading advertising, through telehealth-only providers.

The issue prompted the Australian Health Practitioner Regulation Agency (AHPRA) to take action against 57 practitioners over poor prescribing practices. These businesses used single-issue telehealth services to circumnavigate the patient’s usual GP, resulting in highly fragmented care for a number of vulnerable patients. This led to exceptionally dangerous outcomes including hospitalisations, and a fatality connected to inappropriate prescribing.

‘Medicare is there as an insurance policy for all Australians to be getting the best quality healthcare. It’s not about just providing the pot of gold to a business opportunity.’ – Associate Professor Charlotte Hespe, speaking to the RACGP about telehealth-only providers in 2020.

In the wake of these issues, AHPRA released new guidelines to manage the surge of single-issue telehealth providers.

What Good Looks Like

When used in-line with best practice, telehealth is a valuable tool that enhances healthcare access. An efficient and safe telehealth provision should:

Support Face-to-Face Appointments: High quality telehealth providers often operate a clinic that provides face-to-face appointments as part of their everyday business practice. Telehealth should only be used where clinically appropriate, and as a supplement to standardised face-to-face appointments with your regular GP, Allied Health Professional, or Specialist. In some cases, like psychiatry, telehealth may be used as a long term solution, but this treatment should sit within a treatment plan that is managed by your GP.

Be Part Of An Established Care Plan: Telehealth appointments should be part of your existing care plan. Your care team can assess which appointments are clinically appropriate for telehealth, and when you need to have face-to-face consultations. Your care team should also not encourage you to have a telehealth appointment, if your preference is for face-to-face.

Be Coordinated With Your Existing Care Team: Telehealth clinicians should be part of your existing care team. Your practitioner should understand the greater context of your unique healthcare requirements. This eliminates the risk of receiving fragmented healthcare, which can cause misdiagnosis, delayed care, or medication errors.

Should Meet Standard Appointment Durations: The minimum telehealth appointment duration to qualify for the Medicare Benefit Scheme is 6 minutes. However, your appointment length should be indicated by your GP clinic, even if your health concern is a minor one. Appointment durations are usually capped at: Standard >15 minutes, Long >30 minutes, and Extended >45 minutes.

Engage High Quality Clinicians: It can be difficult to assess the skills of your clinician over the phone. This is why you should only engage telehealth appointments through your established treatment plan, through your care team, managed by your GP. This ensures your practitioner has the appropriate skills and specialisations to address your healthcare needs.

Telehealth: A Key Component Part Of A Strong Healthcare System

While telehealth has transformed Australian healthcare, over-reliance attracts unnecessary risk. Without effective regulation, telehealth-only providers leave themselves open to being manipulated for profit over quality care, leaving patients at risk.

When used by your usual GP and existing care team, teleheath is powerful tool that provides greater healthcare access. As a supplement to face-to-face appointments, telehealth is helping to provide healthcare equality across Australia.

Total Veteran Healthcare is committed to providing ease and speed of access to high quality Veteran healthcare, for all Australian Veterans. We champion face-to-face appointments in our Brisbane clinics, providing telehealth options when determined as clinically appropriate by your GP.

Learn more about how we deliver ease and speed of access to quality veteran healthcare.