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Tuesday, June 28, 2022

Aged care sector stubbornly resisting telehealth uptake in COVID-normal phase

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Telehealth was largely embraced as a vital alternative to in-person medical consultations during the COVID lockdowns, but what is its role now that systems are transitioning to a COVID-normal phase?

Dr Silvia Pfeiffer, CEO and founder of Coviu, Australia’s leading telehealth service provider, says that there is still a convincing use-case for the technology, but that the aged care sector has thus far been resistant to change.

“I’m actually quite disappointed about the aged care sector this far in the uptake with telehealth,” she tells Aged Care News.

“During the pandemic, there were lots of opportunities to bring in telehealth, to bring the doctors into the aged care centres via technology, and yet, it was very difficult to do that in aged care.

“I think it’s got to do with the setup of the residential aged care providers.”

Ensuring aged care facilities have high speed, wireless internet connections that are freely accessible to residents and their families is one of the fundamental building blocks that is often lacking, Pfeifer says.

“You might need to bring an iPad to a patient’s bedside to allow them to have a telehealth consultation, or even a just a video call with their family, but the internet might not have been set up so that they can do that.”

Dr Silvia Pfeiffer, founder and CEO of telehealth provider Coviu, says that ongoing access to telehealth has benefits that extend beyond lockdowns associated with COVID-19.

Unfortunately, recent changes to the Medicare Benefits Scheme (MBS) have wound back incentives for what doctors call “dual-care”, a major set-back according to Pfeiffer.

“We used to have Medicare items that were supportive of dual care situations, particularly with the specialists being remote and the GP sitting with a patient… but these items have disappeared,” she explains.

“It’s particularly sad in aged care, because you need that patient support at the patient end.

“Maybe a resident has dementia or can’t speak properly, or has problems interacting with technology; in that case you actually need somebody to help them set it up and to explain and translate what the remote GP or specialist is saying.”

In remote residential aged care facilities, the function was also useful for areas where GPs were not available locally; in this instance a nurse could be the support person, but it’s a situation now totally untenable due to both a lack of MBS support and worsening workforce shortages.

“That’s a very important function that needs to be done but nurses can’t do it; they don’t have the time.

“Also with our changes in Medicare recently, the patient support services were basically removed for nurses and nurse practitioners … so the business case used to be there and it suddenly disappeared.

“I believe that we will make a big progress with telehealth in residential aged care only when those dual care items come back.”

Furthermore, investment in technological aids such as tablets would be another important step in facilitating elder-friendly access to telehealth.

“You can use your normal phone to receive a consultation with a GP or specialist or even an allied health provider, but it might not be the best for an older person because of the screen size.

Ensuring aged care facilities have high speed, wireless internet connections that are freely accessible to residents and their families, and resident access to iPads or similar sized tablets, are important for telehealth uptake success.

“Probably an iPad is about the minimum screen size you would want to have for an older person to properly see the other person.

Looking towards a future in which healthcare via telehealth is largely normalised, Pfeiffer sees room for a broad range of services, including allied health.

“I don’t just want to talk about specialists and GPs. I definitely want to talk about allied health providers as well.”

In home-care settings, Pfeiffer says that allied health services can be provided both to increase elders’ mobility and functionality, but also to combat isolation through group work.

“So you can think about doing exercise classes … where multiple older people that are getting home-care can be supported at the same time with a physical therapist … or a dietitian that talks to them about the way that they eat, what food to buy, what will keep them healthy.

“These services can be provided remotely and so that reduces the need for travel and definitely gives better and more frequent care.”

But assistance in adjusting to digital modes of healthcare should not just be targeted at the public.

Pfeiffer says that numerous clinicians struggle to administer care confidently through telehealth.

“Imagine people being in rural and remote areas, being far away from a specialist, they’d have to travel for hours, maybe just to get 10 minutes with a specialist. And those 10 minutes might actually be very stressful for them. Because they have to pre-prepare to have everything in their mind and get all the information that they want to get across out.

“We’ve found that clinicians struggle with a couple of things when they start with video telehealth.

“The first thing is actually confidence; they just need to start feeling more confident in front of a camera.

“And so it’s about teaching behaviour, teaching how to deal with the camera, how to set up a camera, that the camera is not pointing at your face and not your belly button!

“Also, making sure that the quality of the camera and the microphone is good enough so that the conversation can be as positive and as well understood as possible.

There are some elements of traditional care that are hard to replicate through a screen, to which Pfeiffer responds that a review of which practices are necessary and evidence-based is needed.

“Doctors might be taught to walk up to the patient and put their hand on a patient’s head just to measure temperature or something like that.

“In fact, we’ve heard from many GPs that they’ve been taught at university that touching the patient provides confidence to the patient that they’re actually being looked after and taken care of.

“Now a lot of that touching is not actually necessary, so they need to sort of untrain certain behaviour and retrain themselves in how to provide better quality care online.”

During the present COVID-normal phase of the pandemic, the public has largely reverted to in-person services, which Pfeiffer says is understandable.

“Certainly people are quite keen to have in-person consultations again … everyone’s been a little bit starved of direct human contact.”

However, for many, telehealth has remained a fixture of their interactions with the healthcare system, boding well for the digital industry’s future prospects.

“We’ve also seen the other way around: we’ve seen a lot of patients wanting to continue doing telehealth because there’s still limitations for patients that are maybe in low-access areas or have mental health issues and don’t want to leave their house for care.

“Some practices have certainly said ‘oh, we won’t do any telehealth, so don’t ask us about it’, but in general we are we are seeing changes of behaviour both by patients and clinicians.

“And it’s certainly continuing to transform the industry.”

More about Coviu

Coviu, an online software that facilitates telehealth consultations with GPs, specialists and allied health profesionals, was created by Pfeiffer in response to research she did when working for the CSIRO on the effectiveness of existing telehealth methods.

Coviu was designed with increased privacy settings and added features tailored to the needs of healthcare professionals.  

“We offer different tools that the clinicians can bring in, for example standardised assessments that patients might need to do, and all those things really help to intensify the conversation between the clinician and the patient,” Pfeiffer says.

“There’s lots of opportunities of making telehealth a better conversation even than being there in person.”

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