Woolworths’ entry into the world of telehealth has thrust the role of remote consultations back into the spotlight, with some doctor groups voicing reservations about businesses that offer these services.
The Royal Australian College of General Practitioners (RACGP) has watched the move particularly closely and is concerned that telehealth services like those offered by Woolworth’s health and wellness subsidiary, HealthyLife, could diminish the quality of care patients receive.
“These services put the onus on patients to know their history and inform their usual GP and other specialists of what medicines, diagnoses, or advice they have been given,” RACGP president Dr Nicole Higgins told Nine newspapers.
But it is asynchronous consulting – such as a service offered via text rather than by phone or video-based telehealth – that has many in the healthcare sector especially worried.
Leading medical defence organisation Avant announced late last year that from 1 January 2023, its indemnity insurance policy would no longer cover asynchronous telehealth services provided without a prior appointment between the doctor and patient, either via phone call, videoconference or in-person.
Coverage was withdrawn for asynchronous telehealth services offering prescriptions, medical certificates, referrals to mental health specialists and pathology or radiology requests.
The change in policy was spurred by past “claims experience”, as well as an assessment of the risks incurred by these asynchronous consults, according to Georgie Haysom, general manager of advocacy, education and research at Avant.
“It is our view that a pre-determined questionnaire consisting of questions relating to a patient’s request for a specific medication or test is unlikely to be a substitute for an appropriate history taking and examination, and this is exacerbated in circumstances where a patient does not have an existing relationship with their doctor,” Ms Haysom said in a statement to Wild Health.
“We are also concerned that this mode of healthcare delivery may lead to fragmentation of the patient’s care.”
According to the RACGP, text-only consulting has its place in healthcare, but only if it is appropriately used alongside in-person care.
The college also emphasised that patients using asynchronous telehealth services should do so through their usual GP or practice to maintain “quality and continuity of care”.
“Asynchronous telehealth is really about sharing patient information that can be assessed offline outside of a consultation to support safe quality care from a patient’s usual GP,” an RACGP spokesperson said.
“There are risks if this is the only method used to diagnose and treat patients as it could result in delayed care and does not allow for a proper evaluation of a patient’s symptoms if information is being exchanged in messages.”
The college said it backed the policy changes made by Avant.
“The RACGP supports medical defence organisations recognising the importance of the ongoing GP-patient relationship, and that new business models, such as those providing text-only consults, risk quality care,” the RACGP said.
According to the member notification issued last year by Avant, doctors will still be covered for telehealth service provision in cases where the patient has previously been seen by another medical practitioner and access is provided to all their medical records.
Ms Haysom said the organisation also welcomed the Medical Board of Australia’s recent consultation on its revised guidelines for telehealth services.
The board has said in its draft guidelines that it does not support practice that “includes requests for medication communicated by text, email or online that do not take place in real time and are based on the patient completing a health questionnaire but where the practitioner has never spoken with the patient”. “Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and management of the patient was appropriate and necessary in the circumstances,” the board said.
