Abstract
Objectives:Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate.Conclusions:Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.
Highlights
In the context of the COVID-19 pandemic, there has been a rapid shift to provision of telehealth in general,[1] and private telepsychiatry, mediated by the new Medicare Benefits Schedule (MBS) telehealth items.[2]
For private psychiatric patients requiring inpatient care, there are no MBS telehealth items for psychiatric consultation. While this might seem intuitive, i.e. that patients requiring inpatient care have more severe illness requiring in-person care and consultation, there remains the possibility that, as a scarce specialist resource, psychiatrists may either not be available or individual psychiatrists might be vulnerable to COVID-19 On this basis, consideration should be given to possible specific conditional options for telepsychiatry for psychiatric inpatients, including for the provision of second/further opinions from other psychiatrists to provide advice for care
While it is reasonable to continue the option of telepsychiatry provision indefinitely during and after COVID19, it remains an individualised decision as to whether telepsychiatry is appropriate for a patient
Summary
In the context of the COVID-19 pandemic, there has been a rapid shift to provision of telehealth in general,[1] and private telepsychiatry, mediated by the new Medicare Benefits Schedule (MBS) telehealth items.[2] Absent the development of a vaccine for COVID-19, social distancing and hygiene measures remain in place in Australia in mid-August 2020, with Victoria introducing Stage 4 distancing restrictions to control the second wave of infections.[3] While direct personal protective equipment (PPE) may not be required unless psychiatrists themselves are vulnerable, it is prudent to consider how private psychiatric practice may continue while reducing the risk of COVID-19 and other communityborne infections.
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