TELECARE SPECIALIST OUTPATIENT OUTCOMES in RRRQ

Full description

Telecare is Australia’s largest specialist telehealth service provider in rural and remote regions of Australia (RRRA), where access to specialist healthcare is challenging. According to the Australian Institute of Health and Welfare’s ‘Australia’s Health 2024’ Report, 28% of Australians live in RRRA and can face unique challenges due to their geographic location. They often have poorer health outcomes compared to people residing in metropolitan areas. This includes shorter life-spans due to increased high risk behaviours (tobacco, alcohol and illicit drug use), higher levels of chronic disease and injury, and poorer access and uptake of health services. Very remote areas have higher substantially higher rates of hospitalisation in public hospitals (678 per 1,000 population) compared to Major cities (224 per 1,000). Non-referred attendances (for example primary care visitations) are also reduced (Australian Institute of Health and Welfare [AIHW], 2022).

Since 2018-19, one in 3 people attend Specialist-care for non-hospital Medicare-subsidised visits, with 98 attendances and $8968 paid per 100 people as of 2022-23. However, there is great variability based on location, for example with 14% of people in the Northern Territory Primary Health Network (PHN) compared to 41% in Northern Sydney PHN attending a subsidised specialist attendance (AIHW, 2023a). Since 2002, telehealth item numbers have been introduced into the Medicare Benefit Scheme (MBS), initially through telepsychiatry programs (2002), then general telehealth (2011), to improve patient access to medical specialists through videoconferencing for patients living in remote locations. In light of the COVID-19 pandemic response, newer MBS telehealth items (video and phone) were created, which removed specific eligibility criteria, providing greater access across Australia. Its use peaked at 6 million telehealth and 4.3 million telephone attendances rendered in 2021-22 when widespread COVID-19 lockdowns were in place across Eastern Australia. Whilst major cities have seen a decline in use of telehealth attendance (18.2 down to 9.2 per 100 people), Remote and Very Remote Australia have experienced a much shallower decline, reflecting the lasting appeal and lack of alternatives of providing healthcare and supporting these communities (AIHW, 2023b). The 2022–23 Patient Experience Survey estimated that for people aged 15 and over who needed to see a medical specialist (in both hospital and non-hospital settings) in the previous 12 months: 22.5% delayed their appointment at least once or did not see a medical specialist when needed. Of this 22.5%, 10.5% of patients cited cost as a reason for delaying or not seeing the medical specialist. 27.9% waited longer than they felt acceptable to get an appointment with a medical specialist. A high proportion reported that the medical specialists they saw ‘always’ listened carefully, spent enough time with them and showed respect (77.9%, 78.9%, and 82.8% respectively). Smaller proportions reported that the specialists they saw ‘often’ displayed these behaviours (13.8%, 11.9%, and 11.1% respectively) (Australian Bureau of Statistics [ABS], 2023). The overall Research question will be split into two sub-questions:

1. To what extent is the Telecare model of care efficient and effective in contributing to reducing health access divide for Rural and Regional Queensland (RRQ), Australia?
2. What factors were the barriers/ challenges and enabling drivers and opportunities in providing access to healthcare close to home in RRRA?