Video consultations have limited role in rural outreach, specialists say


Most specialists involved in rural outreach are using video consultations but telehealth is unlikely to fully replace face-to-face consultations, an Australian study suggests.

Published in Rural and Remote Health, Monash University researchers described the results from a survey of Victorian specialists subsidised by a Federal Government rural outreach policy.

Led by Dr Belinda O’Sullivan (PhD) from the University’s School of Rural Health, it found that video consultations were being used by close to 60% of the 65 respondents, who included paediatricians, cardiologists, obstetricians, nephrologists, urologists and rheumatologists.

Video consultations were used for non-complicated health care, to support rural GPs, undertake clinical reviews or see urgent new patients expediently. They were used for a median of 12 sessions per year, mainly for one patient per session

About half of the specialists said video consultations were valuable because they reduced the frequency of travel to the outreach site. But they used video consultations only for very specific parts of their service and 43% reported that they thought using video consultations took more time than conducting outreach face-to-face consultations.

The ways the technology was being used currently suggested it may not completely replace face-to-face consultations or improve outreach sustainability, the researchers said.

Respondents were generally critical of the quality of video consultation technology with 62% rating it as “medium” and 11% as “low” with problems around reliability, speed and clarity.

Insufficient internet bandwidth, poor stability, low quality connections, poor picture quality, lag and unreliable transmission were all raised as problems.

The most negative views of video consultation technology were held by surgeons, paediatricians, rheumatologists and nephrologists, who commented that the quality was only good enough for non-physical procedures and non-complex consultations.

While sufficient for a surgical follow-up, video technology didn’t make the grade for observing complex behaviour or exploring widespread pain, clinicians said.

One specialist opined that the medium wasn’t as good as a face-to-face consultation, adding little more than a phone consultation, which was just as efficient “but not rebatable on Medicare”.

Of the  40% of specialists who were not using video consultations, around two-thirds thought it could support aspects of their rural work in the form of simple follow-up consultations with stable patients or reviewing those who would otherwise have long travel to make an appointment.

And the key factor that would encourage them to use VC was service coordination.

“A previous survey identified that telehealth coordinators are important to get patients in the virtual room on time, administer appointment reminders, book appointments and test connections,” the researchers wrote.

They said service coordination had the potential to reduce the overall time per video consultation, which would be especially relevant for private specialists paid on a fee-for-service basis.

“Service coordination for outreach visits is supported under the current national outreach policy but could potentially additionally support the use of VC within such services,” they said.

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