OPINION: Rural people have their say on Telehealth


Rural and remote communities have given the 'thumbs down' to the replacement of local on-site GP and Hospital medical officers with Telehealth in a first-of-its-kind study of the attitudes of rural, remote and Indigenous people.


The Rural and Remote Healthcare Survey 2020 is the only one of its type in Australia and asks rural and remote people directly for their views on access to healthcare, GPs and hospital services.

Following controversies around the use of Telehealth in providing emergency care in hospitals, we wanted to understand the views of rural, remote and Indigenous Australians on the use of Telehealth as a replacement for local on-call rural doctors.


The Survey found that while rural, remote and Indigenous people were comfortable using primary care led Telehealth services for routine matters such as medical certificates, repeat scripts from their own doctor and treatments for minor ailments, they drew the line at using Telehealth as a replacement for local on-call GPs in hospital and emergency care.


Unsurprisingly, rural and remote people did not agree that Telehealth is appropriate to treat a patient with internal bleeding in Bourke, deliver a premature baby in Gulgong or treat a group of kids who have been involved in a motor vehicle accident on a farm in Wellington.

They also objected to the idea that people might get bad news, like a cancer diagnosis, over the phone.


You don't have to be a rocket scientist to know that Telehealth cannot replace local hands-on GPs in rural and remote emergency departments without people dying or being injured.


But I would argue that the problem is not Telehealth itself but the model of Telehealth care that is being delivered. And this is strongly influenced by who is delivering the service.


Our health system consists of two distinct parts.


We have a primary care system led by GPs that is built around continuity of the GP:Patient relationship and is focussed on keeping people healthy.


And we have a hospital care system that is built around medical specialties that is focussed on treating disease when the situation becomes acute.


Each part of our health system has a distinct and important role to play, but their roles influence how they see and use Telehealth in delivering healthcare in rural and remote communities.


When we go to hospital we might see one doctor in emergency, another in a speciality area, possible another in surgery and another in recovery. The best way to treat acute conditions is by using different specialists who have the expertise to manage each stage of medical care.


Within a hospital-centric model of Telehealth the idea of seeing different doctors whenever you attend for an appointment is normal because that is the way hospitals are designed to operate.


But that is not what rural and remote people want in addressing their general health care needs. According to the Survey, more than 87 percent of us prefer to receive health care from a GP and only 9 percent from a hospital.


Primary care on the other hand is designed around a long-term therapeutic relationship between a doctor and patient built on trust so they can develop a shared understanding of what is driving poor health and the types of interventions that will contribute to long term improvements in health.


Continuity of care is at the heart of general practice. Patients who receive continuity have better healthcare outcomes, higher satisfaction rates, and the health care they receive is more cost-effective.


Within a primary-care led model of Telehealth the goal is to integrate Telehealth into established health relationships between the patient and their rural GP, pharmacist and other health providers.


Primary care led Telehealth models, like the RARMS Remote GP Service, were co-designed with patients, communities, GPs, pharmacists, nurses and other participants in the primary and hospital care system. It was designed from the bottom-up, rather than top-down.


Developed over 5 years it has been expressly designed to support on-the-ground rural and remote healthcare delivery, not replace it. For example, we use secure electronic transfer to send scripts to the patient's regular rural pharmacist and to update the patient record of the regular GP. This model not only ensure a 93 percent clinician satisfaction rate, and more than 90 percent of patients as well.


Telehealth is playing a much bigger role in the delivery of health and hospital care in rural and remote communities today, and that is a good thing.


In primary care, it is supporting doctors to deliver continuity of care by making it easier for rural and remote patients to see their local GP to get access to life-saving care 24 hours a day, 7 days a week. It can make rural practice more attractive for GPs in the knowledge that their patients can access high quality care and that they will remain at the centre of their patient's health care.


For hospitals, it is helping to reduce low acuity presentations by building the patient load of local rural GPs (rather than competing with the local GP), increase after hours care, facilitate ward rounds and reduce unnecessary patient transfers.


The Survey shows that rural, remote and Indigenous people intuitively have a better understanding of the types of health care delivery that suit the needs of their own communities. I think as policy makers we would benefit from putting down our pens and going out and talking to rural and remote people. This Survey shows that they have a lot to offer in designing Telehealth policies to address rural and remote community needs.


A copy of the Survey Report is available here.

RARMS is the largest charitable provider of on-site GP and hospital medical officer services in rural and remote NSW. It serves more than 22,000 active patients in the most disadvantaged and vulnerable communities in NSW. More than 26 percent of its patients are Aboriginal and Torres Strait Islanders.


Mark Burdack is the CEO of RARMS and a Hon Adjunct Senior Lecturer in the La Trobe University School of Rural Health. Mark Burdack previously led the Charles Sturt University rural dental school initiative and the rural Murray Darling Medical School initiative to train more rural kids to become doctors and dentists in rural and remote communities.


For further information please call Mark Burdack on 0418974988.



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ACKNOWLEDGMENT OF ABORIGINAL AND TORRES STRAIT ISLANDER SOVEREIGNTY

We pay our respects to all Aboriginal and Torres Strait Islander Elders past, present and future from the lands and waters where RARMS works and that it serves.  We acknowledge the Wiradjuri (Gilgandra, Warren, Orange), Gamilaraay (Walgett, Collarenebri, Lightning Ridge, Goodooga, Inverell), Wailwan (Brewarrina), Ngarabal (Tenterfield), Wongaibon (Bourke), Awabakal (Hamilton), Eora (Sydney) and Ngunawal (Braidwood) as the historic sovereigns and traditional oweners of the land and water on which we work, and the Barundji, Barranbinya, Muruwari, Barindji, Gunu, Nganyaywaa, Gundungarra, Ngarigo, Wandjiwalgu, Bandjigali, Bundjalong and other Aboriginal and Torres Strait Islander peoples who use our health and social services.