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Is Primary Care Locking In The Digital Gains Of Covid-19?

Ninety percent of general practices have returned to to seeing the majority of patients in person, a new survey shows.

When the country moved to Alert level four in late March, GPs were asked to do a virtual consult with every patient before seeing any in person. This dramatic shift to using telehealth saw some practices conduct almost all of their consultations over the phone or via video during lockdown.

By early June, half of practices had returned to seeing the majority of patients in person, but by the end of the month that had risen to 90 percent.

The figures are the results of a series of national surveys conducted by Auckland University asking general practices about their experience with Covid-19 and its aftermath, attracting between 150-170 respondents each time.

But despite some practices returning to ‘business as usual’ post-lockdown, there are encouraging signs that some of the digital gains will become permanent.

The surveys also reveal that by the end of June, less than half of practices reported that patients were struggling with telehealth and 43 percent were still conducting video- consultations and 98 percent were still doing telephone consultations.

A step forward

Royal NZ College of GPs chair Samantha Murton says because lockdown happened so suddenly and practices were forced to take a ‘digital first’ approach with patients at speed, it made the process stressful and did not give time to create a seamless digital experience.

Most ‘virtual’ interactions with patients were phone calls and some practices continue to use telehealth and portals as much as possible, especially in areas where people continue to be more wary of the Covid-19 threat, such as Auckland.

However, she says there are still glitches in the electronic systems which means they do not always run seamlessly, such as electronic prescribing, which has a number of potential failure points along the way from the GP to the pharmacy then the patient.

“That six weeks probably took us a step forward and as processes become embedded and seamless it will make take-up much quicker, but there’s always some level of slip back,” Murton explains.

“It’s about realising those gains and making sure the digital processes that are useful continue as most of us know that taking technology and running with it is really important: because if we don’t, other services will do it.”

Into lockdown and beyond

Data from Pinnacle Midlands Health Network comparing this year with last shows that 70-80 per cent of consults during lockdown were provided virtually, compared to about 10-20 per cent normally for that period, with the vast majority being by telephone.

Ventures chief data officer Alex Poor says use of virtual and telehealth solutions increased by more than 230 percent in 2020, to more than 8,300 virtual consults across the network during March and April. This increase was driven particularly by large uptake with Pacific patients (more than 640 per cent), Māori patients (more than 400 per cent) and Asian patients (more than 400 per cent).

“We knew such a rapid shift to virtual care would not be sustainable – lockdown was the key driver of change and once it ended many practices and patients would revert to their usual behaviours,” he says.

“Overall virtual care has just about halved in the last month, with the change predominantly in telehealth, whereas video has remained about the same.

“About one-fifth of our practices are doing the same or more virtual consults than during lockdown, and approximately one-third of our practice network is continuing to offer virtual health as a core service.”

Patient get used to portals

Poor says portal use in the Midlands region also more than doubled during lockdown, driven by higher volumes of email consultations alongside a 64 per cent increase in requests for repeat prescriptions. Practices also had an influx of about 30 times more 'miscellaneous' messages when compared with 2019.

In the 3DHBs region which covers Capital and Coast, Wairarapa and Hutt Valley DHBs nearly 8000 new patients registered for a patient portal between February and May 2020.

Figures from ProCare PHO show the number of patients using a patient portal was 237,000 in May 2020, up slightly from 222,000 in July last year with around 40 percent of patients currently using the portal.

During lockdown, the number of appointments being booked online at ProCare practices drastically reduced, while the number of repeat prescriptions ordered electronically spiked in March at more than 8000, which is around double the average in previous months.

ProCare associate clinical director Janine Bycroft says a lot of practices turned off online booking functionality during lockdown because all patients needed to be screened before getting an appointment, but they have opened up the functionality again.

The huge increase in electronic prescriptions requested in March was due to lockdown being announced and everyone suddenly wanting their prescriptions filled.

She says experience from overseas is that portals could be used to better engage with patients and keep them informed and she hopes to see that develop in the future.

“Portals are still relatively immature in New Zealand in terms of how we use them: the functionality is still limited,” says Bycroft.

Murton says in her experience it is the practices themselves that need to promote the use of portals to patients as very few ask about them independently.

“During lockdown we were trying to keep people more electronically connected so there would have been a lot more drive to use the portal and make it available,” she tells eHealthNews.nz

Murton says secure messaging with patients has certainly increased, which is great for connecting with patients and providing a quick response. However, she says email conversations can sometimes become detailed and lengthy, which creates issues regarding costing and payment as it takes up a lot of clinical time.

A long-term shift

Bycroft says practices and patients need support to work through challenges such as health and digital literacy, access to technology and security and privacy issues to ensure telehealth and portals are used appropriately and do not exacerbate inequities in the system.

“It (lockdown) was all so sudden we didn’t really maximise the opportunity, but I’m really keen to see the shift to telehealth continue because there’s a huge advantage to patients in terms of convenience and access. It’s about supporting that shift on a long-term basis and I’m sure we will, it just takes time and needs a multi-pronged approach.”

GP at Hora te Pai Chris Fawcett says his practice has continued using telephone triage in Alert level one and in the month following lockdown, 28 percent of patients were still dealt with by the GP on the phone

He says the ‘digital first’ approach has improved access with a “significant” decrease in Did Not Attends, which has also reduced the need for patients to go to the local emergency department.

The recently released Health and Disability System Review says there needs to be concerted focus on ensuring consumers have the tools to manage their own health and navigate the system and virtual (telehealth) services should be established to provide consumers with greater access to services.

The report notes that progress has been made using patient portals in primary health care. But says there has been inconsistent uptake and use across the country.

“There is a need to provide consumers with easy access to all their own health information allowing them, where appropriate, to manage, update and contribute to their own data and to consent to their data being shared with whānau and caregivers,” it says.

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