This appeared a few days ago:
Telehealth triage 'not safe' for chest pain: study
Findings from a Dutch out-of-hours service shows phone triage underestimates the condition in more than one quarter of patients
22nd September 2020
GP out-of-hours phone triage systems for chest pain are neither safe nor efficient, a Dutch study suggests.
The researchers found the system underestimated the urgency of chest pain in more than one quarter of patients whose pain later proved to be either acute coronary syndrome (ACS) or another life-threatening event.
The team from the Julius Centre for Health Sciences and Primary Care in Utrecht listened back to telephone conversations with more than 2000 patients who called the GP out-of-hours service between 2014 and 2016.
They compared these with final diagnoses recorded in medical notes.
Overall, 11% of patients who called with chest pain had ACS (men 15%, women 8%) and 3% had another life-threatening event.
Of these, 27% had their chest pain rated as non-urgent.
After nurses' gave their input this figure fell to 14% .
“Primary care semi-automatic assisted telephone triage of patients with chest discomfort is not safe or efficient,” the researchers wrote in Open Heart.
More information: Open Heart 2020; 21 Sept
More here:
https://www.ausdoc.com.au/news/telehealth-triage-not-safe-chest-pain-study
What this says to me is that as we see new models of remote care delivery being implemented we need to make sure we are carefully evaluating for both short and long term harms and risks.
Such wholesale changes in the way care is delivered are unlikely to be utterly free of side effects and we need to be really alert to them happening.
In another related issue we see that policy around telehealth may still need some tweaking.
Early medical abortion: telehealth restrictions discriminatory
Authored by Cate Swannell
TELEHEALTH restrictions introduced by the federal Department of Health on 20 July 2020 discriminate against women seeking early medical abortion (EMA), making an already hard to access procedure even more out of reach.
Professor Danielle Mazza, Head of the Department of General Practice at Monash University, told InSight+ that telehealth offers an opportunity to address limited access to EMA during the COVID-19 pandemic and beyond.
“Telehealth is an amazing tool to increase equity of access because if you can’t get that service provided to you locally, you can get the service provided to you by another provider in a different geographical location,” Professor Mazza said.
“At the moment, 2317 GPs in Australia are currently registered prescribers of MS2Step (mifepristone and misoprostol), but we think far fewer actually go on to actively prescribe.
“Actually, setting up this service in your practice involves a number of other steps and having the confidence to do it, plus having the support of your colleagues in your practice, the front desk manager and the reception staff.
“So, you can do the course [in order to become a prescriber], but that doesn’t mean you’re actually going to deliver the service.”
“Telehealth therefore helps women to overcome that problem of not having a local provider in their region.”
With the advent of the COVID-19 pandemic the federal Department of Health introduced temporary Medicare Benefits Schedule (MBS) item numbers for telehealth GP consultations to enable patients to see their doctors in a contactless environment.
But since 20 July, new restrictions to those MBS item numbers have been implemented, namely restricting eligibility to only patients who have visited the GP or practice in the previous 12 months or those who have been referred by a specialist, except for where there is a current lockdown in place.
“The changes that were introduced on 20 July were trying to support continuity of care, and that’s a very important principle,” Professor Mazza said.
“I’m a GP. I understand the benefits of continuity of care, but you can’t have continuity of care if you don’t provide a service.”
In a Perspective published today by the MJA, Professor Mazza and colleagues wrote that the new restrictions “will greatly reduce women’s access to EMA”.
“Placing restrictions on the eligibility criteria for MBS-subsidised telehealth services severely affects women’s access to GPs who can provide EMA, and discriminates against women who have not recently engaged with a GP due to various forms of disadvantage, such as family violence and unemployment.
“Exemptions to the restrictions have already been identified for people who are homeless and for children aged less than 12 months.
“Therefore, a further exemption should also be issued so that registered prescribers of medical abortion are able to use MBS telehealth item numbers for the benefit of Australian women.”
Lots more here:
All this reflects we need to keep a
careful watching brief as the technology is rolled out. Wholesale change can never be assumed to be safe and free from the famous 'unintended consequences'.
David.
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