AMA warns of ‘opportunistic’ telehealth models

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As doctors call for telehealth provisions to become permanent, pharmacy stakeholders have some concerns: remuneration for pharmacies, and whether takeup is being quantified

The Australian Medical Association says that Australian patients are “overwhelmingly” embracing telehealth, and called for the recent reforms to be made permanent after the COVID-19 pandemic.

AMA president Dr Tony Bartone says such a permanent system should follow the “proven” approach of building it around the relationship between a usual GP and a patient.

“One suggested approach is to allow GPs or general practices to allow patients to voluntarily nominate a GP and/or a practice in order to be able to access telehealth services from their GP once the current interim telehealth arrangements are due to end,” he said.

Dr Bartone also hinted at opposition to pharmacists being included in such a model, however.

“We need to avoid ‘pop up’ or purely ‘virtual’ opportunistic other models of telehealth that fragment care and, in some cases, blur the important distinction between the prescribing and dispensing of medicines,” he said.

PSA national president Associate Professor Chris Freeman told the AJP that PSA is supportive of ongoing Telehealth services for medication reviews including MedsChecks, HMRs, and RMMRs.

“Unlike general practice, pharmacy has not seen ‘pop-up’ providers of telehealth services, which appear to be of varying quality, and appropriateness,” Dr Freeman said.

“We encourage GPs and other telehealth providers to use these services judiciously and appropriately.”

Dr Bartone, Dr Freeman and Pharmacy Guild Victorian branch president Anthony Tassone agreed that while important, telehealth should not replace in-person consultations.

“Telehealth is not and is never likely to be a complete substitute for face to face visits to the doctor, but does provide a convenient and highly appropriate option that can supplement visits to the practice in person,” Dr Bartone said in the AMA’s statement.

Chris Freeman said that “Telehealth consultations should never replace face to face consultations but are valid alternative in some instances”.

And Mr Tassone said that the COVID pandemic has presented the health system with a range of challenges in terms of how care can continue to be delivered for patients. 

“Telehealth and the greater use of technology has helped provide continuity of care for a range of patients and in different settings – and it would make sense for some form of remunerated telehealth to continue on the other side of the current pandemic,” he said.

“In saying that, as useful as telehealth and technology can be as a tool to facilitate access to care – there is no substitute for face to face interaction with health professionals and should be seen complementing face to face care and not seeking to replace it.”

Mr Tassone said that the question is not whether community pharmacies should participate in telehealth or not “as we do each and every day”, or whether there should be expansion of medication management services to include telehealth delivery.

“The real question needing answering is: why aren’t community pharmacies receiving remuneration or rebates for participation in this mode of care as what is provided to a GP or other health professionals?

“A simple example is quality use of medicine services provided by community pharmacies to aged care facilities or an Aboriginal medical or health service that may include patient education regarding their medicines; medication adherence assessment, clinical intervention and chronic disease management to name a few; and prescription and medication chart follow ups to prevent any interruption of treatment.

“If patients benefit, and there is greater assurance of access and continuity of care – then the use of technology is a good thing, however there must always be true patient choice of their healthcare provider and informed consent at all times in how and where they receive their care from.”

The PSA has another concern: that pharmacist services via telehealth aren’t being counted.  

According to the AMA, around 10 million Medicare-funded telehealth services have been provided, either over the phone or via video, a significant majority of which have been provided by GPs and other specialists since the Medicare telehealth items were introduced in March.

But Dr Freeman warned that, “We remain concerned however that there is no ongoing data capture about how many medication reviews and in what circumstances they are being conducted by telehealth”.

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