For meaningful change, telehealth services need to be accessible to all

COVID-19 has fundamentally changed the way most Australians engage with healthcare, whether it be at the GP, community health centres, or in hospitals.

Distance-based care such as telehealth is now likely to become a consistent feature of community-based care models well into the future.

Most Australian healthcare practices are using it, sometimes exclusively, providing convenience for the patient. There are, however, significant barriers to access depending on patient demographics and economic backgrounds.

For some patients, being able to see their doctor, midwife, or other allied health provider online, at home, and at a time that works for them, simply works better.

There’s no commute, no concern about childcare, no waiting in a crowded reception area, allowing time to engage more with their doctor, either over the phone or via video.

Unlike pre-COVID-19 times, GPs are now compensated by Medicare for the service, and many have come to appreciate the simplicity of telehealth for uncomplicated interactions such as script repeats and referrals.

Read more: COVID-19, and the pandemic winds of change in healthcare

However, in some situations, telehealth consultations may require additional expense and complexity for the patient.

For example, in pregnancy, women may need to purchase their own machines to measure blood pressure and/or weight gain. They may also be required to measure the height of their growing pregnancy (fundal height), and report on this during the telehealth consultation.

Additionally, some healthcare requirements are difficult to undertake over the phone or by video, such as family violence screening or risk assessment.

For some, telehealth is inaccessible and cannot substitute in-person care. For example, within a month of Australia’s initial COVID-19 lockdown, utilisation of mental health services was down, despite increased public anxiety related to the pandemic. Similarly, breast care screenings dropped dramatically, from 70,000 in March 2020, to 1100 the following month.

Some under-served groups are at particular risk as Australia moves towards telehealth-centric health provision. This includes people experiencing or at risk of homelessness, people with poor access to digital technologies, people with low digital health literacy (or low health literacy, more generally), people with disability (such as those who are deaf, or who experience hearing or vision impairments), and people from non-English-speaking backgrounds.

While this is fundamentally an issue of human rights and equity, this also matters, because it costs the Australian taxpayer money.

Limited screening and diagnostic opportunities, and the delay of health-seeking behaviour, often result in more complicated presentations, which in turn add greater financial burden to the healthcare system, and can reduce the chances of a complete recovery.

How to make healthcare more accessible

So, what do we do?

How do we use digital technologies, and telehealth specifically, to make healthcare more accessible, rather than less?

Firstly, we need to consider how people with known barriers to access, such a low English proficiency, have overcome these concerns prior to COVID-19.

For example, free phone interpreting services have been available through TIS National, GPs, and government-funded hospital and health centres for years. Video interpreting services are also available, and pilot programs of in-house interpreting services are underway in a number of hospitals, including the Royal Melbourne Hospital and Alfred Health.

There’s still a long way to go, however, in ensuring allied health professionals receive this same service. There’s also no MBS item number for interpreters, so consideration is sometimes undertaken for extending appointments if clinically justifiable. The RACGP has released a guide to telehealth consultations using an interpreter.

Secondly – and perhaps more importantly – if we’re to expect this first step to be successful, we need to ensure health services and their providers are culturally responsive.

This entails a model of care that takes into account a person’s social determinants of health, as well as their spiritual beliefs and worldviews, to ensure healthcare planning works best for the patient and their particular circumstances.

Read more: Getting the most out of your telehealth consultations during COVID-19

Globally, there’s been a move towards more person-centred, culturally responsive care.

Across Australia, there are countless resources and tools available on cultural safety and training on cultural sensitivity available to health providers both online and in person.

When care providers and health systems fail to take into account the nuances of individual people’s lives and experiences, health outcomes suffer, and health costs rise as a result.

Digital platforms as a health hack

While providing care through digital platforms is no longer new, it’s rapidly evolved as a health hack in part due to COVID-19 lockdowns and social distancing restrictions.

The communities most at risk of suffering ill health due to traditional care pathway disruptions are the same communities who are also most likely to face barriers to accessing the new models of care developed to adapt to COVID-19.

Inclusive and equitable health systems design, centring these communities, is the only way to bring about meaningful change in the digital health space. Without their voices and lived experiences, we risk a reduction in quality healthcare access and provision at a cost of both lives and taxpayer dollars.

Our team at Monash Centre for Health Research and Implementation is currently evaluating telehealth across a number of areas of women’s health, including pregnancy focused on equity, with the aim to inform services that are accessible to all.