Kia ora koutou - In the rural community where I work as a GP, there has been (and will be!) a struggle to maintain a prescriber (GP/NP) on-call, in-person workforce for after-hours. For a range of complicated, local political power-struggle factors, our community’s PHO was a barrier to promoting the use of Ka Ora Health here.
As we are trying to work towards a more sustainable and efficient model, I am loudly touting the benefits of a prescriber telehealth WITH an in-person service (e.g., nurse, health-care-assistant). As I read about the plans for a ‘national telehealth’ service, some points that might benefit from further discussion:
‘Clinician Elsewhere’ - the term ‘telehealth’ can be a significant barrier for many, as the assumption is there is no in-person component to such a service. Without an in-person component, access is reduced due to:
Whakawhanaungatanga (e.g., rapport, trust, relationship, local context, etc).
Access to technology, including connectivity
Disability (e.g., visual, hearing, cognitive)
Medicines access when pharmacy closed
Health measurement equipment: barriers- cost, maintenance, confidence to use
Injury management
Hybrid models - this seems the best of both-worlds. There are several services I’m aware of where people can attend a facility (mobile or fixed), where a nurse and/or healthcare assistant provides in-person care with the support of prescriber via telehealth.
This has existed for years and so needs to be articulated . . . every time an ‘on-call’ person is contacted by phone for advice, and does not need to attend, this is tele-health. Therefore, ‘hybrid’ telehealth is what we’ve had for decades . . it’s just not been described as ‘telehealth’.
Single Telehealth service - As the government looks at options, is there a role for CiLN to advocate for more than one provider of telehealth??
Any system that has a single product for an essential service (e.g., singular EHR), risks market monopoly and eventually stifles innovation
Ka Ora Health is working well, with the advantage of their unique focus on rural communities with the specific factors to consider (e.g., distance to travel for referrals; after-hours access to medicines; etc.). Conversely, other telehealth providers may be more suited for other regions.
Yep, hybrid is what we have been pushing for, integrated or at least interoperable data sharing but with choice of mode of consultation - both provider and patient /whānau choice which may be negotiated based on clinical condition and personal situation. Trust in whatever system/mode is chosen by all parties is essential.
Look out of the upcoming RFP when it comes out, and it should detail out the standards that would be expected for the service provider. It’s due out any day now.
Hybrid models are the way to go. We need to invest more in infrastructure, information sharing and improving access to health services to support for patient/whanau choice and address the workforce issues. There is no one solution.
Just doing some hybrid-telehealth today for our rural clinic → we are facing a huge crisis of no longer having a robust medically-trained, specialized General Practitioner workforce. The clinical capacity for care in the community exponentially increases, which is where we all want that to go, but that increasingly means complex chronic care needs medical management in the community. However, that management is still not seen as akin to hospital-based outpatient work, even though the level of complexities can be even more (multiple co-morbidities). There is still expectations of after-hours provision, too. We all want to keep people out of hospital, but the health needs are still there and needing medical management.
So, a possible way forward is having tele-health be formally recognized as part of traditional GP care. This requires socializing this thru national health promotion.
Can the new ‘national telehealth’ initiatives be more than a singular contract for one provider, but rather a strategy to support hybrid telehealth across the board??
A Nan just hang up on me because she was adamant that she needed to ‘see a doctor today’, even though she could have seen a very senior RN today and a doctor on Monday. I felt that her understanding of seeing an RN in-person, with a ‘doctor elsewhere’, was unfortunately influenced by media, etc, where ‘seeing a doctor in-person’ is seen as gold-standard, even if we’ve been delivering care with a doctor or senior doctor elsewhere for years.
My city-based GP provider has telehealth as an option on Manage My Health - ie I can opt to get a phone call from my doctor, rather than make an appointment, which is often better. But how do people who are not enrolled access telehealth services (apart from Healthline?) That is where the real need is. I like the idea of a ‘hybrid telehealth’ supporting primary health care across the board.
@Mhead , Ka Ora Health is available at reasonable co-payments for rural residences after-hours, regardless of enrollment status. I think anyone, enrolled or enrolled, can access existing telehealth services during the day (e.g., PracticePlus, Tends, etc) . . .
Yes, I think RESOURCING integration of clinician else-where for traditional GP practices, for their enrolled population, will ensure the best quality care (patient medical record known, context known, ability to transfer to in-person care if required within the service, etc). It’s likely best for patients AND clinicians (working from home is a game-changer for those of us with young families and if working at rural places at a distance from home).
After-hours for me is a separate workflow, and ideally is an in-person hybrid model. I think registered nurse +/- HCA is the most feasible and cost-effective, where there could be a Standing Order local service with a local prescriber, for conditions deemed appropriate, and then accessing a national after-hours prescriber service, if a prescriber required . . .
Thanks Emily and, of course, ensuring interoperability on a regional level. Apparently this doesn’t yet include anaesthesia (I am the Snr Policy Advisor for ANZCA)
Yes, I think that model would work well. It would be helpful to have regulated standards around this - what is safe and what is not for practitioner and public, otherwise it is a bit of a no-man’s land.It was only when a woman bled to death in an aged care facility in 2005 (I think from memory!) where there wasn’t anyone who even held a first aid certificate that a few rules were laid down. It would be best to put in some safety measures from the outset, not expecting or hoping the practitioners will be able to make that call.
