A meta-analysis has concluded that telehealth in Australia generally maintained the use of GP services during the covid-19 pandemic and minimised out-of-pocket costs, but not for everyone.
The study published in the British Journal of General Practice analysed the data of over 19 million Australians (roughly 81% of the total census population) to understand how the pandemic and the widespread introduction of telehealth affected access to general practise and patient costs.
In the period of March to December 2020, almost 86% of people saw a GP, either face-to-face or via telehealth, compared to nearly 90% in the same period of the previous year. About 49% of people used telehealth to access GP services at least once in this time, up from less than 2% in the same period in 2019.
It was concluded that this maintenance of services was not true for all groups. During the early pandemic, total GP use (telehealth and face-to-face) was markedly lower for children, people with limited English proficiency, and those aged 70 and older.
GP services delivered by telehealth in this time were also proportionately lower in the older population and those with limited English proficiency. The analysis also suggests that males, people with low education or low income, and people living regionally or remotely did not access telehealth as much as the rest of the population.
Generally, groups such as females and those ages less than 70 years of age are more likely to use GP services. This remained true in the age of free telehealth. However, patients not proficient in English were less likely to access telehealth despite being as likely pre-pandemic to use GP services as those proficient in English.
International data in other studies have shown similar trends in uneven telehealth usage across different population subgroups. In the US, adolescents, older people, those on low incomes, and ethnically and linguistically diverse groups had lower uptake of telehealth services. It has been suggested that this may be representative of pre-existing inequalities in access to healthcare.
Before March 2020 in Australia, telehealth accounted for less than 1% of Medicare-subsidised consultations. Two months into the pandemic, telehealth accounted for 36% of all GP consults, and remained at around 20% for the rest of 2020 and 2021.
In the early months of the pandemic, telehealth services were provided at no cost to patients and a substantial drop in out-of-pocket GP costs was noted. There was some reversal of this decline by the end of 2020 as patient gap fees were put in place.
The data was taken from the Multi-Agency Data Integration Project, which was linked with Australian Bureau of Statistics, Medicare Consumer Directory (records of those covered by Medicare), Department of Social Services Data, and the personal income tax database. The researchers say that this comprehensive data linkage effectively gave complete coverage of the resident population. Using the census data as well, comparisons were made between 2020 and 2019 to show the differences to GP use due to covid.
