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      Use of General Practitioner Telehealth Services During the COVID-19 Pandemic in Regional Victoria, Australia: Retrospective Analysis

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          Abstract

          Background

          In March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the COVID-19 pandemic.

          Objective

          This study sought to assess use patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic and with or without a lockdown) in regional Victoria, Australia.

          Methods

          We conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in Western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (ie, videoconference vs telephone) and by geographical, consumer, and consultation characteristics were analyzed.

          Results

          Telehealth comprised 25.8% (522,932/2,025,615) of GP consultations over the 2-year period. After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (including telephone and video services), from 0% before COVID-19 to 15% (11,854/80,922) of all consultations in March 2020, peaking at 55% (50,828/92,139) in August 2020. Thereafter, the use of telehealth declined steadily to 31% (23,941/77,344) in January 2021 and tapered off to 28% (29,263/103,798) in June 2021. Telephone services and shorter consultations were the most dominant form, and those aged 15-64 years had higher telehealth use rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdowns and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas.

          Conclusions

          Our findings support the continuation of telehealth use in rural and regional Australia post pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consultations.

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          Most cited references38

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          State of Telehealth.

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            Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic

            Key Points Question What sociodemographic factors are associated with higher use of telemedicine and the use of video (vs telephone) for telemedicine visits for ambulatory care during the coronavirus disease 2019 (COVID-19) pandemic? Findings In this cohort study of 148 402 patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older age, Asian race, non-English language as the patient’s preferred language, and Medicaid were independently associated with fewer completed telemedicine visits. Older age, female sex, Black race, Latinx ethnicity, and lower household income were associated with lower use of video for telemedicine care. Meaning This study identified racial/ethnic, sex, age, language, and socioeconomic differences in accessing telemedicine for primary care and specialty ambulatory care; if not addressed, these differences may compound existing inequities in care among vulnerable populations.
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              Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

              Background To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. Aim To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Design and setting Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. Method Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices’ experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. Results There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. Conclusion The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                2023
                7 February 2023
                : 25
                : e39384
                Affiliations
                [1 ] Deakin Health Economics, Institute for Health Transformation School of Health and Social Development Deakin University Burwood Australia
                [2 ] Global Centre for Preventive Health and Nutrition, Institute for Health Transformation School of Health and Social Development Deakin University Geelong Australia
                [3 ] Biostatistics Unit Faculty of Health Deakin University Geelong Australia
                [4 ] Menzies Institute for Medical Research University of Tasmania Hobart Australia
                [5 ] Deakin Rural Health School of Medicine Warrnambool Australia
                [6 ] Western Victoria Primary Health Network Geelong Australia
                [7 ] Centre for Quality and Patient Safety Research, Institute for Health Transformation School of Nursing and Midwifery Deakin University Burwood Australia
                [8 ] School of Nursing and Midwifery Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Australia
                [9 ] Institute for Health Transformation School of Health and Social Development Deakin University Burwood Australia
                Author notes
                Corresponding Author: Anna Peeters anna.peeters@ 123456deakin.edu.au
                Author information
                https://orcid.org/0000-0002-0383-812X
                https://orcid.org/0000-0003-3736-4337
                https://orcid.org/0000-0001-6444-6827
                https://orcid.org/0000-0001-9734-1140
                https://orcid.org/0000-0002-2858-4621
                https://orcid.org/0000-0001-6547-9153
                https://orcid.org/0000-0002-8514-1763
                https://orcid.org/0000-0002-3470-4298
                https://orcid.org/0000-0001-6820-6193
                https://orcid.org/0000-0002-3747-0087
                https://orcid.org/0000-0003-4340-9132
                Article
                v25i1e39384
                10.2196/39384
                9907565
                36649230
                4202827a-937e-4228-9be4-ddc043fd766c
                ©Feby Savira, Liliana Orellana, Martin Hensher, Lan Gao, Andrew Sanigorski, Kevin Mc Namara, Vincent L Versace, John Szakiel, Jamie Swann, Elizabeth Manias, Anna Peeters. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 07.02.2023.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 9 May 2022
                : 6 October 2022
                : 25 October 2022
                : 27 November 2022
                Categories
                Original Paper
                Original Paper

                Medicine
                telehealth,rural,australia,covid-19,ehealth,primary care,general practitioner,gp,trend,pandemic,equity,video,virtual,consultation,telephone

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