De Guzman Keshia R, Snoswell Centaine L, Smith Anthony C
Centre for Online Health, The University of Queensland, Qld, Australia; and Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia.
Centre for Online Health, The University of Queensland, Qld, Australia; and Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia; and Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark.
Aust Health Rev. 2022 Oct;46(5):605-612. doi: 10.1071/AH22058.
Objective To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021. Methods An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes. Results After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant. Conclusions The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services.
目的 研究2019年1月至2021年12月新冠疫情期间远程医疗政策变化对澳大利亚全科医生（GP）诊疗活动的影响。方法 采用中断时间序列分析，以分析通过医疗保险福利计划（MBS）引入的两项重大政策变化对GP诊疗（面对面、视频会议、电话）活动的影响。第一项政策变化是2020年3月30日通过MBS引入额外的新冠疫情远程医疗资金。第二项政策变化是2021年7月1日将电话咨询时长限制在20分钟以内。通过这些MBS政策变化，比较干预前后时期的GP远程医疗服务提供率和活动情况。结果 第一项政策变化后，远程医疗服务提供显著增加，同时面对面诊疗减少（P < 0.0001）。然而，在第一项政策变化后的几个月里，远程医疗服务提供减少（P < 0.0001），而面对面诊疗活动增加。第二项政策变化后，最初视频会议服务提供增加（P < 0.0001）。然而，此后所有远程医疗活动均减少。在第二项政策变化后的几个月里，面对面（P = 0.700）、电话（0.199）和视频会议（P = 0.178）诊疗的月度活动减少并不显著。结论 引入额外的远程医疗资金和限制电话咨询时长促进了远程医疗服务的初步提供和增长。然而，这些政策变化并未维持远程医疗活动的长期上升趋势。远程医疗政策应增加提供适当和可持续的GP远程医疗服务的机会。
