Introduction

Internationally the COVID-19 pandemic has triggered a dramatic and unprecedented shift in telehealth uptake as a means of protecting healthcare consumers and providers through remote consultation modes. Early in the pandemic, Australia implemented a comprehensive and responsive set of policy measures to support telehealth. Initially targeted at protecting vulnerable individuals, including health professionals, this rapidly expanded to a “whole population” approach as the pandemic evolved. This policy response supported health system capacity and community confidence by protecting patients and healthcare providers; creating opportunities for controlled triage, remote assessment and treatment of mild COVID-19 cases; redeploying quarantined or isolated health care workers (HCWs); and maintaining routine and non-COVID healthcare.

Purpose

This paper provides a review of the literature regarding telephone and video consulting, outlines the pre-COVID background to telehealth implementation in Australia, and describes the national telehealth policy measures instituted in response to COVID-19. Aligned with the existing payment system for out of hospital care, and funded by the national health insurance scheme, a suite of approximately 300 temporary telehealth Medicare-subsidised services were introduced. Response to these initiatives was swift and strong, with 30.01 million services, at a cost of AUD $1.54 billion, claimed in the first six months.

Findings

This initiative has been a major policy success, ensuring the safety of healthcare consumers and healthcare workers during a time of great uncertainty, and addressing known financial risks and barriers for health service providers. The risks posed by COVID-19 have radically altered the value proposition of telehealth for patients and clinicians, overcoming many previously encountered barriers to implementation, including willingness of clinicians to adopt telehealth, consumer awareness and demand, and the necessity of learning new ways of conducting safe consultations. However, ensuring the quality of telehealth services is a key ongoing concern.

Conclusions

Despite a preference by policymakers for video consultation, the majority of telehealth consults in Australia were conducted by telephone. The pronounced dominance of telephone item numbers in early utilisation data suggests there are still barriers to video-consultations, and a number of challenges remain before the well-described benefits of telehealth can be fully realised from this policy and investment. Ongoing exposure to a range of clinical, legislative, insurance, educational, regulatory, and interoperability concerns and solutions, driven by necessity, may drive changes in expectations about what is desirable and feasible – among both patients and clinicians.

中文翻译：

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“几天之内完成十年的工作”：澳大利亚全民远程医疗之旅

介绍

在国际上，COVID-19 大流行引发了远程医疗的巨大和前所未有的转变，作为通过远程咨询模式保护医疗保健消费者和提供者的一种手段。在大流行初期，澳大利亚实施了一套全面且反应灵敏的政策措施来支持远程医疗。最初的目标是保护弱势群体，包括卫生专业人员，随着大流行的发展，这种做法迅速扩展为“全民”方法。该政策响应通过保护患者和医疗保健提供者来支持卫生系统的能力和社区信心；为轻度 COVID-19 病例的受控分诊、远程评估和治疗创造机会；重新部署被隔离或隔离的医护人员 (HCW)；并保持常规和非 COVID 医疗保健。

目的

本文回顾了有关电话和视频咨询的文献，概述了澳大利亚实施远程医疗的 COVID 前背景，并描述了针对 COVID-19 制定的国家远程医疗政策措施。与现有的院外护理支付系统保持一致，并由国家健康保险计划提供资金，引入了一套约 300 项临时远程医疗医疗保险补贴服务。对这些举措的响应迅速而有力，前六个月申请了 3001 万次服务，耗资 15.4 亿澳元。

发现

这一举措在政策上取得了重大成功，在充满不确定性的时期确保了医疗保健消费者和医护人员的安全，并解决了医疗服务提供者已知的财务风险和障碍。COVID-19 带来的风险从根本上改变了远程医疗对患者和临床医生的价值主张，克服了许多以前遇到的实施障碍，包括临床医生采用远程医疗的意愿、消费者的意识和需求，以及学习新的实施方式的必要性安全咨询。然而，确保远程医疗服务的质量是一个关键的持续关注问题。

结论

尽管政策制定者更喜欢视频咨询，但澳大利亚的大多数远程医疗咨询都是通过电话进行的。电话项目号码在早期使用数据中的显着优势表明视频咨询仍然存在障碍，并且在通过该政策和投资充分实现远程医疗所描述的好处之前，仍然存在许多挑战。在必要性的驱动下，持续接触一系列临床、立法、保险、教育、监管和互操作性问题和解决方案，可能会改变患者和临床医生对可取和可行的期望。