Telehealth: just as good or better for patients and clinicians

A sample of almost 600 patients who have received a telehealth consultation either by phone or video have rated the experience well, with 62 per cent saying their telehealth experience was “just as good” or “better” than a traditional in-person medical appointment.

Another survey of more than 1300 doctors found they too rated the experience well, with 87 per cent saying they were interested in continuing to use telehealth if there was ongoing MBS funding.

Posted in Australian eHealth

Tags: Telehealth

Comments  

+2 # Andrew Baird 2020-10-01 09:14
Re: The patient survey, conducted by researchers from the University of Sydney's Sydney Health Literacy Lab.

This is a pre-print. It has not been peer reviewed and published.

The authors define telehealth/tele medicine as a consultation by either phone or by video. The discussion and analysis do not distinguish between video and phone as the mode of telehealth.

71.6% of participants had consultations by phone, 14.1% had consultations by video, and 14.3% had consultations by both phone and video.

The authors do not distinguish between video consultations and phone consultations in the 'Reasons for telehealth visits being worse than in-person medical visits' (Table 4).

The survey did not collect any information about the type of telehealth service that participants attended. All telehealth services have been 'lumped' together here. We don't know what proportion are for GPs, Specialists, Allied Health, Psychologists, etc.

I think, overall, the best that we can get out of this is that there is support amongst participants for the concept of non-in-person healthcare consultations.
0 # Shyan Goh 2020-10-01 10:35
You also forgot that the telehealth survey occurred between June 5 to June 12 2020, hence the actual relevant telehealth sessions likely to happen in the preceding months during the height of fear and movement restrictions, with about half had only one telehealth encounter, another quarter only had 2.
It will therefore be interesting to see how many people actually continue with telehealth and for what reason.
Babylon's GP At Hand in UK had disproportional ly high younger users of the service compared to normal face to face GP cliente, and 25% of initial registrants stop going within 3-6 months (and the survey which formed the basis of the research lauding the "success" of GP At Hand involved only those who remained on the register after 6 months!) plus GP At Hand was actually in metro London.
It will be interesting to see how many actually kept going with telehealth post pandemic, and how many of these involved rural/remote residents? Some may not see telehealth as a trade-off or compromise in health standard (even though it is obvious to all that phone only sessions involving more than 2/3 telehealth has very limited ability to provide standard care), thus holding the doctors to the same expectations; AHPRA may do the same (my impression is about 5% of recent complaints to AHPRA involved telehealth but I cannot verify where I read this).
There is no doubt some consultations are appropriate especially mental health, and non face-to-face discussion follow-up of test results (which GP previously unable to bill) but ultimately the responsibility of the appropriateness of telehealth in medico-legal speak sits squarely on the doctor not the patient, even if the latter demands it. Hence while there are initial enthusiasm for non face to face consultation during a healthcare crisis, the need and appropriateness of telehealth may very well recede to far lower numbers than it is now, especially if some consultations (retrospectivel y judged inappropriate particularly with self proclaimed 'naive' consumers) may expose practitioners to unnecessary risk in pursuit of customer "convenience"
0 # Andrew Baird 2020-10-01 12:34
Hi Shyan, re 'You also forgot that the telehealth survey occurred between June 5 to June 12 2020, hence the actual relevant telehealth sessions likely to happen in the preceding months during the height of fear and movement restrictions', just for clarification, the survey participants were asked to describe their telehealth experiences for the period from the start of pandemic restrictions in Australia (20 March) to the date of the survey (5-12 June).

This period is consistent with the description in the title of the research paper: 'People’s experiences and satisfaction
with telehealth during the COVID-19 pandemic in Australia'
0 # Shyan Goh 2020-10-02 12:38
Hi Andrew
I am simply pointing out the panic and the fear in the first 3 months of the pandemic which is still on-going as I write.
Looking around me in Queensland the community behavioral change in movement from Jan to April, and then to Sept is dramatic (and even more so in healthcare service utilisation), and hence I suggested that "it will therefore be interesting to see how many people actually continue with telehealth and for what reason"; afterall taking a snapshot of what happened in the initial stages of the pandemic (associated with compromise accepted then) would not reflect the entire experience still ongoing
0 # Andrew Baird 2020-10-02 16:39
Hi Shyan, you can get that data from the Centre for Online Health, UQ. Their data show the %age of consultations that were in-person, by phone, and by video. The data are for GPs and Specialists. There are also data for Mental Health Clinicians and Allied Health Professionals. Unfortunately, the Centre for Online Health has only been able to report data up to and including June, as Medicare have not yet reported their data for July, August, and September. (The Centre for Online Health reports are based on Medicare data).

https://coh.centre.uq.edu.au/telehealth-and-coronavirus-medicare-benefits-schedule-mbs-activity-australia

If you go to the Medicare data, you will be able to get a breakdown by State, but the data are only available up to and including June

http://medicarestatistics.humanservices.gov.au/statistics/
0 # Shyan Goh 2020-10-02 17:48
Hi Andrew
Interesting stats on COU; thanks for directing me to that
CFF: Consultation Face to Face
CT: Consultation Telehealth
Comments
1. For GP, CFF dropped off in April but the rise in CT more than made up the decline in CFF (hence actually more encounters than usual), probably partly because previously unbillable phonecall followup now billable... among other reasons
2. For non-GP non psych specialists, CFF dropped off but the rise of CT does not replace the shortfall, hence specialist encounters definitely reduced
3. For psychiatric/men tal health care, the CFF fall is mostly matched by CT rise; no big change in encounter
4.For Allied health (AH), Nurse practitioners (NP), CFF did not fall (and may in fact have a hint of increase), rise of CT contributed to at least an increase (for AH, 5%, for NP 20%) in encounters.
Not sure if this is offset by changes in hospital care, since not all state health service had embedded MBS billing for outpatient services (I will avoid discussing the issue of legality under the funding model)
So, in addition to PSR review of unsolicited consultation, it may also be interesting which group of practitioners will come under the microscope.
0 # Shyan Goh 2020-10-02 17:51
Sorry I should really use the COU nomenclature
Consultation Face to Face is In-person Consultation!
0 # Andrew Baird 2020-10-03 07:36
Hi Shyan,

You may be interested in my analyses of the MBS data for GP consultations for March, April, May, and June this year. Let me know and I'll post a link to the reports. .

I agree re terminology. F2F is ambiguous - it could be 'in person' (practitioner and patient physically present in same room), or it could be virtual (video).
0 # Shyan Goh 2020-10-03 09:53
Hi Andrew
Please post your link to your analysis
0 # Andrew Baird 2020-10-03 11:10
Hi Shyan,

I'll ask Pulse+IT to send the files to you.

It's not possible to attach files to comments here.

I prefer not to post a public link to the files.
+1 # Kate McDonald 2020-10-03 11:40
Shyan, email me at kate.mcdonald@pulseit.news and I'll send you Andrew's analyses.
0 # Shyan Goh 2020-10-07 10:47
Hi Ms McDonald
I did email you yesterday and I wonder if you received it?
0 # Kate McDonald 2020-10-07 10:58
Yes, I forwarded Andrew's email to you yesterday.
0 # Andrew Baird 2020-10-01 12:49
Hi Shyan,

I cannot find any reference to complaints to AHPRA relating to telehealth. I have checked the newsletters for the past six months. AHPRA has published guidance for practitioners on telehealth, https://www.ahpra.gov.au/News/COVID-19/Workforce-resources/Telehealth-guidance-for-practitioners.aspx

The '5%' that you quote may have come from the Avant Practitioner telehealth survey? This survey (referenced in the article above) reported that '5% of respondents said a patient had made a complaint to them (or their workplace) that they believe was a result of telehealth'.

The Avant survey report describes the complaints as relating to several issues, including:

billing disputes when patients didn’t think they should pay for telehealth
patient’s wanting to have a face-to-face instead of a telehealth consultation
misunderstandings due to the lack of non-verbal cues.
0 # Shyan Goh 2020-10-02 12:44
Hi Andrew
I am unsure how that figure came into my head (with so many webinars including Avant and Medical Board chairperson) and you might very well be right that I may have wrongly attributed the figure to AHPRA, rather than Avan,t for which I apologise unreservedly
0 # Shyan Goh 2020-10-02 12:52
Hi Andrew
Having attended many webinars recently relating to telehealth and online medicine (including presents from Medical Board and Avant), I suspect I may have wrongly attributed this to AHPRA, for which I unreservedly apologise for suggesting a un-attributable statement.
0 # Shyan Goh 2020-10-02 13:01
Sorry I meant presenters not 'presents"!
0 # Andrew Baird 2020-10-02 16:32
LOL - it would be great to get presents from the Medical Board and from Avant. Free medical registration? Free indemnity cover? Hmm .. probably not :-)
0 # Shyan Goh 2020-10-02 17:54
Hi Andrew
You realise of course presents and gifts can be pleasant or unpleasant/unwa nted.......
0 # Shona Gallagher 2020-10-01 13:47
These cyber utopian views of telehealth are disturbing and perpetuate an inaccurate reality. This is because they fail to account for poor internet service in regional areas and users/patients who are not masters of their devices. Re: The patient survey, conducted by researchers from the University of Sydney's Sydney Health Literacy Lab, recruitment for this study is fundamentally flawed. An online recruitment process means that the cohort of participants excludes telehealth users who are not regularly online or social media users. In our metropolitan oncology practice we have a large number of regional patients aged over sixty-five years who could potentially benefit enormously from telehealth. Unfortunately the reality is a miserable experience for patients and practitioners alike. We use it as a last resort.
0 # Andrew Baird 2020-10-01 14:12
Agree. I think the authors accept that they've got a skewed sample.
It's disappointing that telehealth is a last resort for you. I assume you're referring to video, not to phone?
Could you please describe a bit about the 'miserable experience'?
I'm in metro general practice, so no problems with internet connection (although Healthdirect video call only requires 300kbps!). A minority of patients who consult me have problems using their devices. Being elderly doesn't seem to be a risk factor for device incompetence. Healthdirect video call is very user friendly. However, I don't know about using non-healthcare video platforms, eg Zoom, Skype, etc. Clearly telehealth experiences will differ based on location, demographics, and so on.
+1 # Shona Gallagher 2020-10-01 14:29
Andrew I agree that age is not the issue but user experience and attitude. The misery of our experience often involves flustered and embarrassed patients who express their fear as anger. We also have extremely time pressured practitioners who are not accustomed to providing IT support. Here are some actual examples of issues we have encountered:
1. Patient didn't enter meeting and didn't answer video calls, voice call or text. Apparently she had issues with Wifi and service and didn't receive our calls/texts this morning.
2. Pre-screened patient said she was familiar with FaceTime. At time of consultation Patient did not understand what Facetime entailed. She had a Samsung device, couldn't use text or email. She also has "patchy" reception and often calls drop out.
3. During pre-screening patient said he would use Desktop PC for consult but then decided to use iPad. Then refused to download Zoom and for Google Meet he didn't want to update new iOS version.
4. Patient was using another persons computer so initial confusion in who was entering the meeting
5. Delay in the video and about 1 minute of no audio at the beginning. Presume issue establishing connection. Dropped in an out of audio occasionally.
6. Issue with microphone on patient end. No sound coming through to us. We tried to phone the patient to troubleshoot mic without luck. Ended up on phone with patient at same time.
7. Problems with bandwidth or service reception. Patient ended up driving for better reception and using iPad from their car for consultation.
8. Patient did not understand how to move the phone to angle camera for a photo of surgery site.
We have had excellent telehealth experience with patients and doctors in remote as opposed to regional areas but this is because there is typically a patient and practitioner in the room together and the practitioner is accustomed to the technology aspects of telehealth consults.
0 # Andrew Baird 2020-10-01 15:05
Hi Shona,

Thank you very much for your comprehensive reply, and thank you for the examples of the 'miserable experience'. I see that there have been significant and frustrating problems for practitioners and patients.

For what it's worth, I would suggest having a look at Healthdirect Video Call, or Coviu (Healthdirect Video Call is the Australian Government subsidised version of Coviu). Healthdirect Video Call has been designed to reflect clinical practice workflows, its bandwidth requirements are low, it does not require any downloads or log in or registration, it uses secure encrypted browser-to-brow ser web RTC technology. Patients are sent a link, they click on the link, they enter their name and phone number, and they are 'transferred' to a virtual waiting room. From the patient end, that's it. Video and audio are set up by the system. I have no affiliations with Healthdirect Video Call or with Coviu - other than being a satisfied user.
0 # Shona Gallagher 2020-10-01 15:34
Hi Andrew
Thank you. We have tried Coviu, Pexip, and Teleconsult and encounter the same problems. Every product claims to work seamlessly but that is not our experience. In desperation we abandoned telehealth designed software and are currently offering patients a range of video conference platforms. Our goal is to try using a product with which they are already familiar and for which the settings of their device are already configured.
0 # Shyan Goh 2020-10-02 13:00
Hi Shona
On the other end of the spectrum, I had heard from colleagues where it transpired mid-phone consultation that the patients were doing it in public places, including Bunning stores.
Having patients with such blasé approach, may not always be a problem... until there is a problem.
Hence I felt that any practitioner doing Telehealth should really be prepared for it especially medico-legally, not just the practical issue and Medicare billing side of things.
0 # Shona Gallagher 2020-10-02 15:31
Hi Shyan
I agree completely, so much focus has been on logistics that the clinical disadvantages of telehealth are being overlooked, many of which will ultimately result in compromised care. We had a similar Bunnings experience with a patient driving while participating in the consultation. Our telehealth practice policy, an ongoing work in progress, tries to manage these clinical issues with a combination of pre-screenig interviews and questionnaires with patients and clinicians. If a patient is suitable for telehealth we advise them to treat the telehealth consult as they would a regular consultation. This means including a friend or relative in the consultation if that is what they would do if attending in person. One of our primary clinical concerns is how telehealth restricts our ability to care for patients holistically eg you cannot judge how well a patient walks into the room, you cannot hear if this movement causes them to be more out of breath than the last time they were seen, you cannot weigh them on your own scales to confirm concerns about their nutrition. And we all know patients who are good at hiding symptoms, or who come in thinking they have one problem only to learn they have another, or who who have a pathologically optimistic attitude towards investigation results. Where are the guidelines for breaking bad news in Bunnings?
0 # Andrew Baird 2020-10-02 16:09
Hi Shona,

Bunnings' staff are trained in BBN. They have to tell customers that a sought-after item is out of stock.

That consultation should never have occurred, and it certainly indicates deficiencies in patient information and pre-screening.

A video consultation enables an indirect physical examination.

General observation (the 'eyeball' check),
mental state examination,
distress/pain,
movement,
pulse, BP (if patient has an automated sphyg),
resp rate, work of breathing, SpO2 (some patients have oximeters!), abdominal tenderness/peri tonism,
limited locomotor exam (get up and walk, turn around, move limbs, etc), neuro screening exam, (gait, speech, tremor, weakness, 'facial droop', coordination, dysdiadochokine sis, etc)
rashes and 'spots'. High definition photos of rashes and lesions can be sent to the practitioner (securely) via the video call.

Even the mouth and throat can be examined (I have diagnosed quinsy by video).

It's not possible to examine the ear canal, TM, eye, heart sounds, lung fields, abdo masses, power, sensation, reflexes, so clearly if these need to be examined, or if the indirect examination is not adequate, then an in-person consultation will be required.

Patient safety always comes first, closely followed by practitioner safety, so it's good to have a very low threshold for in-person review if not satisfied with video consultation.

I have no evidence to support this contention, but I believe that BBN done well via video will be better than BBN done badly in-person. I would still prefer BBN in person, because that's what I'm familiar with, but I guess it depends on the nature of the BN. Also, we need to start thinking about video as a new paradigm in doctor-patient communication.
0 # Shona Gallagher 2020-10-02 17:24
Hi Andrew
In our surgical oncology practice we have been conducting video consults with regional and remote patients for a number of years. Video is not a new paradigm for us. In our experience telehealth can be a useful tool but it has significant limitations. Unfortunately these limitations are poorly understood by many patients and clinicians. The USYD research quoted in this Pulse-IT article glosses over these limitations. Furthermore it contributes to a discourse of evaluating digital healthcare tools according to patient perceptions of convenience rather than the clinical quality of their care.
0 # Andrew Baird 2020-10-02 18:02
Hi Shona,

I'll defer to your experience over a number of years with video consultations. It's disappointing to learn that there have been 'significant limitations', and that these limitations have been poorly understood.

Video consultations are still a 'new paradigm' for me, and I would think that's the case for most GPs. In fact, most GPs are using audio-only (phone) telehealth. For GP telehealth consultations in May and June this year, 97% were by phone, and only 3% were by video.

Telehealth has enabled GPs, staff, and patients to reduce the risk of transmitting SARS-CoV-2 by patients not attending Clinics for in-person consultations. This is a major advantage of telehealth.

Telehealth has reduced the risk of patients transmitting SARS-CoV-2 to other patients, to GPs, and to staff in GP Clinics, as patients do not need to attend Clinics for an in-person consultation. Similarly, telehealth has reduced the risk of GPs and staff transmitting SARS-CoV-2 to patients who attend their Clinics.
0 # Andrew Baird 2020-10-02 15:42
Hi Shyan, patient in Bunnings? Hmm... sounds like a blase approach by both patient and practitioner.

The Medical Board of Australia, RACGP, ACRRM, RACP, other Colleges, and MDOs, publish guidelines on phone and video consultations, and it would surely be very wise for practitioners to be familiar with these guidelines, and to practise accordingly.

The following are mandatory at the start of any telehealth consultation:

1. Check AV working at both ends (Can you hear me/see me?)
2. Check patient's identity (cross check personal details with medical record and/or check driver licence (only works with video of course))
3. Check location (in case emergency services needed) - might not be home address
4. Patient alone in private room? If others present, they must be identified, and must be within view (video) . Definitely no consultation if patient is in a shared room, in public, in a shop, walking in the street, or driving - even if the patient says 'it's okay' (try explaining that one to the Medical Board ... )
5. Patient has phone with them?
6. Practitioner will phone patient if the phone or video call drops out
7. Screen for symptoms of serious disease - urgent action required (pain, breathlessness, drowsiness, feeling faint, limb weakness, bleeding) - customise your own list here
8. Consent for consultation by phone or video instead of in-person
9. Consent for billing for consultation
10. Neither practitioner nor patient will record audio or video of consultation

This is necessary. It takes less than 2 minutes (unless issues are identified). You can set up a short-cut in your clinical management program both as a prompt and as documentation.

It's also necessary that the patient knows the procedures for the phone consultation or the video consultation.

Before the consultation, the patient must have information about
- contraindicatio ns to telehealth,
- attendance alone (except if parent or carer etc),
- private room,
- phone available,
- billing,
- how to attend the consultation (eg will practitioner phone the patient? does patient have to log in to a virtual waiting room (eg Healthdirect Video Call, Coviu), will practitioner/pr actice phone/send sms when practitioner is ready for the consultation?)
- what to do if the practitioner has not attended when the consultation is scheduled to start? (eg wait 5 minutes, phone practice, etc)
This information can be provided on the Practice website, or it can be sent to the patient by email.
0 # Shyan Goh 2020-10-02 18:30
Hi Andrew
Just wondering which medical/profess ional guidelines says anything about patient's obligations regarding recording audio or video of consultation, other than the individual state-based Act where present?
AHPRA can come down hard on practitioners recording without permission regardless of jurisdiction but for patients its another ballgame.
0 # Andrew Baird 2020-10-02 20:31
AHPRA and RACGP guidelines do not refer to recording consultations. ACRRM guidelines 'recommend that consultations are not recorded', and that if a consultation is recorded, then consent for this should be in writing. Avant advises 'caution'. You're right, legislation differs between States and Territories.

Trying to put it all together:

If the doctor wants to record the consultation (video or audio-only) then the doctor must explain the purpose of the recording, the intended use of the recording, and the storage of the recording. The recording should be stored in the patient's record (could be a big file...). The patient can be given a copy of the recording. It's vital that the doctor keeps the original just in case the patient alters their copy. The patient must give informed consent to the recording as described, and this should be in writing (which is a problem when the consultation is by telehealth)

If the patient wants to record the consultation, then the patient needs to provide a plausible reason (not 'just because I want to'). For example, so that the patient can use the recording to discuss the consultation with relatives, or so that the patient can check information and so on. The doctor should stipulate limits on the use of the recording - for example, only for the patient's personal use, not to be uploaded to any social media, YouTube, etc. The doctor's consent to the recording, the limitations on the use of the recording, and the patient's agreement should be documented. Preferably, the doctor should record the consultation (so that the doctor retains the original), and provide a copy to the patient. If the patient records the consultation, then the agreement should include a requirement for the patient to give an unedited copy to the doctor.

If the patient records the consultation without the doctor's consent, and the doctor later finds out that the consultation was recorded (eg the consultation is shown on YouTube, social media etc), then the patient has recorded a private conversation without consent, and, in most jurisdictions, this is a criminal offence (Surveillance Devices Act). As you say, the legislation differs in different States and Territories.

Of course, criminal offence or not, it's too late if the recording has already 'gone viral' online.

I think it's okay to say to a patient that recording of the consultation is not permitted without your consent, and that by recording a consultation without your consent the patient may be committing a criminal offence.
0 # Shyan Goh 2020-10-07 11:28
Hi Andrew
Do you ask or say all these things about recording for Telehealth session or in-person consultations? It may be "just take a few extra seconds" to ask the patient, but the few times when the patient ask why not (even if they werent planning to do it) does end up taking more than a couple of minutes to sort out, and may confer sense of "something to hide" and the thinking "no other doctors had asked about it".
Mind you I do have an issue with covert recording but I don't think "educating" the determined patient on the legality issue will necessarily deter them from doing it. While I generally assume my consultation may very well be recorded, I do worry about covert recording especially in an in-person consultation.
I have no evidence in what I am about to say (and I did spent 5 mins looking for it online), but there are anecdotal experience that voice-activated recording can vary depending on quality and software behind the machine. Voice-activated recording function do not record sound until a certain frequency/ampli tude threshold, thus the recording sounds clean with no background noise during pauses and actually uses less memory for those stored in digital memory (but not in tape). The problem is sometimes some people's voice is just not the kind that gets recorded well in this mode (those who record university lectures in the last millenium will know sometimes the recording miss the first few words) and if covertly recording this problem is worse. Furthermore some noise cancelling technology is now inbuilt in microphone esp those hand free phone kits, so if someone had a problem with getting other people to hear them while using one device but not the other, it may very well be because of this. Of course if you send the recording to an professional sound editor they can detect something is missing or not recorded or even edited, but we dont live in a Hollywood thriller movie with access to this kind of service.
Anyway the point I am making is while I have a problem with covert recording (regardless of legality of it), I end up assuming the consultation is being recorded anyway but the main problem will be that the sound recording can compromised technically or by editing with vexatious/malic ious intent
0 # Andrew Baird 2020-10-07 14:25
All I say is, 'It's a legal requirement that neither you nor I record this consultation'.

So far, patients seem to have accepted this.

I haven't been asked, 'Why?'.

If asked, 'Why?' my response would be, 'Our consultation is a private conversation. Recording a private conversation without both persons' consent is illegal. I don't consent to recording of the consultation'. If a patient asked, 'Why don't you give consent?' I would reply, 'I don't consent to the recording of any consultations, not just to the recording of this consultation. This is to avoid the potential risk of a recorded consultation being used in an unauthorised way (for example, sent to someone else, posted on social media), or altered from the original recording.' This is what I have written on my website - although I don't that patients read this.

The issues you raise about covert recording, and adaptive recording (noise-cancelli ng/voice-enhanc ement) are clearly very important in this context.

I have no legal expertise, I'm out of my depth here. I would defer to the MDOs for advice on this.

I would expect that a medicolegally valid recording of a consultation would need to be the original, unmodified, and unadapted version. I have no technological expertise, I'm out of my depth here. IT Specialists have methods for determining the authenticity of a recording to determine if it is the original or a modified version.

I don't know how it's possible to stop patients making covert recordings, either for in-person consultations, or for telehealth consultations.

Any ideas?
0 # Andrew Baird 2020-10-01 17:05
Hi Shona,

Thank you for your comments about the video platforms. This must be disappointing and frustrating for you, your colleagues, and your patients. It's extra work to arrange to use the patient's preferred video platform, and it means that your system has to be compatible with their preferred video platform.

Would others please describe their experiences with video consultations?
0 # Andrew Baird 2020-10-01 20:42
Re: The Avant Telehealth Survey.

I can't find any reference to ethics approval. Does anyone know if this survey has ethics approval?

I note that respondents who provide telehealth reported an average of 34% consultations by audio/phone compared to 17% by video.

That is, 33% of non-in-person consultations were by video.

Based on Medicare data for May and June this year, consultations by video were for only 3% of non-in-person consultations by GPs. For Specialists, consultations by video were for 16% of non-in-person consultations. These data have been reported by the Centre for Online Health, University of Queensland.

The percentage of non-in-person consultations that were by video seems high in the Avant survey.
0 # Andrew Baird 2020-10-06 15:28
I received a reply from Avant. The survey did not have ethics approval as it was considered 'low risk'.
0 # Shyan Goh 2020-10-07 10:56
Sorry Andrew, but did you think the survey should have been requiring ethics approval? (not trying to be argumentative here but just wondering about your logic and expectation)
Firstly it would have been a voluntary survey for the members
And there would usually be some attempts at explaining the aims T & C clauses as well
Members would have some expectations the result will be made available to members +/- public
And individual responses and respondents would normally not be identified in a questionnaire survey nor affect their premium
It would have been not much different from say a newspaper survey although more involved than a yes/no click bait in the daily rag
0 # Andrew Baird 2020-10-07 14:42
The AVANT Telehealth Survey is 'low risk' as participants were anonymous. The only identifying factor is that the participants are AVANT members, as the survey was only sent to AVANT members.

You are correct, ethics' approval is not required for a 'low risk' survey of this nature. However, AVANT could still have applied for ethics approval, and obtained ethics approval. It wasn't essential, but it would have added some credibility to the survey.

Ethics approval is a proxy for quality in research. Research that has met the standards for ethics approval has better academic standing and better academic credentials than similar research that has not met the standards for ethics approval.

The absence of ethics approval for the AVANT Telehealth Survey supports my belief that it's a low-quality survey, not dissimilar to the quality of a news media survey. Interpretation of the AVANT Telehealth Survey findings should be in the context of the limitations of the Survey. I am not sure if the Survey's findings are all that credible or significant.
0 # Andrew Baird 2020-10-02 07:38
Re: “More than one third of respondents who are providing telehealth (37%) do not have guidelines, or sufficiently clear guidelines at work to determine who should be offered a telehealth consultation.”
Plenty of resources here https://www.racgp.org.au/clinical-resources/covid-19-resources/telehealth and here http://www.ehealth.acrrm.org.au/ , Membership not required.

The telehealth preamble (phone and video) should include:
1. Location (which might not be home address) - important to know where the patient is if emergency services are required
2. Privacy - patient alone in a private room? (not driving, not sitting in a cafe (couldn't do that in Melbourne anyway ...) )
3. Screen for symptoms of serious disease - urgent action required (pain, breathlessness, drowsiness, bleeding)

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