I’ve seen the challenges faced by rural communities when it comes to accessing specialist healthcare. While improving infrastructure and attracting more doctors to these areas can help long term, a solution that brings about immediate change is desperately required.
We simply cannot afford to wait.
It’s not practical for many specialists to service regional areas with low population density, spread over vast areas. The time spent travelling reduces specialist efficiency and makes servicing regional areas unattractive, especially when compared to metropolitan work. This leaves many patients with little choice but to travel lengthy distances for specialist care, resulting in significant financial, time and environmental costs.
We need to focus on finding solutions that can help improve access to specialist care now. One of the most promising solutions is the use of innovative, technology-enabled virtual care. This can include virtual consultations, telehealth services, and remote monitoring.
Virtual care has the potential to bridge the gap between rural communities and the specialist care they need. By providing access to specialist care through innovative technology, we can help improve health outcomes for patients in these communities and reduce the burden of long-distance travel.
A neurologist colleague recalled a case where his patient was experiencing episodes of visual disturbance (amaurosis fugax) which was basically a warning of an impending stroke due to a carotid artery plaque. The nearest neurologist was 150km away with a waiting list of 6-12 months.
The patient was able to be seen within a day and, with the use of the virtual clinic’s existing technological infrastructure, the patient was able to have all the necessary investigations. He was then admitted to the stroke unit at a tertiary hospital within a fortnight where he received all the necessary treatments.
Without access to such virtual healthcare services, the patient may have experienced a stroke and became part of the number that makes up the over-representation of stroke in regional Australia as per the latest Stroke Foundation report in 2020.
Despite literature supporting the use of virtual care models to bridge the inequity that pervades rural Australia, we’ve seen resistance within health organisations to adopting virtual care. A 2021 comparison study in telehealth adoption in Queensland hospitals demonstrated that the main barriers include a lack of funding, onboarding support and clinician willingness. Ironically, metropolitan hospitals showed higher adoption and expansion rates to their telehealth models.
Virtual care is not inferior to in-person care.
In-person care has obvious benefits such examination, however this needs to be balanced against the financial, environmental and time costs associated with the travel required to facilitate in-person care in regional settings. An article in JAMA demonstrated that the provisional diagnosis established over video telehealth consultations matched the in-person reference standard diagnosis in 86.9 per cent of cases. This represents a high degree of diagnostic accuracy and is superior to not receiving any healthcare at all.
We must find solutions that are both attractive to patients and specialists alike. The allure of the large hospital resources in major metropolitan centres and access to good schools will always be a strong driving force that pulls specialists to big cities. We have seen the government implement rural bonded university places which mandate doctors serve several years in regional areas.
While these schemes have been successful in increasing doctor supply to remote communities, too often we see these doctors return to metropolitan areas when their moratorium has been lifted. Virtual care allows high quality care to be delivered in a way that is efficient and desirable for patients and specialists.
While improving infrastructure and training more doctors in rural and regional areas may be a long-term solution, it will not solve the immediate problem. We need to focus on funding virtual care to help solve this problem now and bring about immediate, sustainable change.
Dr Chris Sia is a nephrologist and co-founder of virtual specialist services provider Telecare.
