Abstract
BackgroundSince the World Health Organization declared COVID-19 a pandemic on 11 March 2020, health technologies have been rapidly scaled up to ensure access to care. A significant innovation has been telehealth in general practice. Now widespread, it remains unknown how this shift to virtual care has impacted on quality-of-care indicators such as pathology testing and diagnosis.AimTo undertake a comparison of telehealth and face-to-face general practice consultations to: identify if there were differences in the proportion of pathology test referrals from 2019–2020; and quantify any change in pathology test collection and follow-up patterns.Design & settingRetrospective observational study of routinely collected electronic patient data from 807 general practices across New South Wales (NSW) and Victoria, Australia.MethodMultivariate generalised estimating equation models were used to estimate the proportion of pathology test referrals for overall, face-to-face, and telehealth consultations. Pathology test follow-up was described through median (and interquartile range [IQR]) time.ResultsPathology test referrals declined during periods of high COVID-19 cases, falling from 10.8% in February 2020 to a low of 4.5% during the first peak in April. Overall, pathology test referrals were lower for telehealth than face-to-face consultations. Median time between referral and test collection was 3 days (IQR 1–14) for telehealth and 1 day (IQR 0–7) for face to face.ConclusionFor telehealth to become part of routine care, it is crucial that gaps in functionality, including difficulty in test referral processes, be addressed. Quality improvements supporting care practices will ensure clinicians’ workflows are supported and patients receive diagnostic testing.
Highlights
In the COVID-19 pandemic, innovative solutions were quickly needed to address the safety and access concerns faced by both patients and general practitioners (GPs) during enforcement of COVID-19 restrictions
Pathology test referrals declined during periods of high COVID-19 cases, falling from 10.8% in February 2020 to a low 4.5% during the first peak in April
How this fits in Pathology testing is an essential factor in quality-of-care delivered by GPs
Summary
Attending medical appointments was an approved reason for leaving home[1], there was a severe initial drop in face-toface visits from March-June 2020. This drop was seen across the states of Victoria and New South Wales (NSW)[2] including an Australia-wide decline by ~25% compared with the previous year[3]. While telehealth in Australia was previously limited to rural and remote populations for specialist care, requiring a visit to general practice or a hospital[9,10,11], this was different: the first widespread rollout of telehealth in general practice, allowing all patients access to remote consultations with their GPs from their homes and enabling GPs to bill for telehealth. It remains unknown how this shift to virtual care has impacted on quality-of-care indicators such as pathology testing and diagnosis
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