While some health practitioners and patients across the Hunter have welcomed the emergence of telehealth to mitigate the risks of COVID-19 transmission, others have remained sceptical about its efficacy.
Despite the many differing opinions on contactless consults, one observation is universal: the service has not been without its challenges.
Hunter health clinics have been using telehealth as a primary tool during the pandemic, and many health professionals believe the convenience it offers means it is here to stay.
Dr Nick Zdenkowski from Hunter Valley Oncology said that “telehealth is great”, and said the offering brought benefits and was “well worthwhile” for both patients and himself.
“I’ve found telehealth to be very useful and I’m strongly supportive of it continuing beyond the pandemic,” he said.
The oncologist said that sometimes a physical appointment was not necessary, so replacing it with a “phone consultation means patients can get on with their lives”.
“As a specialist, I see patients from all over the place. Sometimes they might travel for a couple of hours to come and see me for a 20-minute appointment.”
He conceded, however, that patients were not making routine appointments during the pandemic, despite telehealth offerings.
“The whole pandemic has led to more telehealth, which means that we can’t do physical examinations for patients,” he said.
“This might mean more imaging, scans and blood tests as we can’t do physical examinations. Some patients are not coming in for their routine visits and they may just not have their medical visits at all.”
Dr Zdenkowski said that preventative healthcare was being somewhat neglected, which was concerning for those at risk of cancer.
“There are routine colonoscopies not being done; they’re not having those routine conversations with doctors about lifestyle factors that impact on cancer.
“We know that maintaining a normal weight, minimising alcohol intake and regular physical activity all reduces the risk of cancer. And [people] are not having those conversations with their doctors because people are less likely to be physically attending.”
Dr Zdenkowski said there must be “better infrastructure” implemented for telehealth going forward.
At first, he suggested “a universal video telehealth” platform for “patients who struggle with the current video platforms”.
“I just use telephone a majority of the time because it’s too hard for many patients to use video,” he said.
He also cited a streamlined system that supported “universal electronic prescriptions and requesting of other investigations like scans and x-rays”.
“Now it involves lots of email and faxes; it’s an administrative burden. [Implementing] a universal electronic health record to support that is going to be pretty critical for the future of medicine.”
New challenge for health practitioners
For one local occupational therapist, telehealth has not been easy.
Working with patients who are vision impaired, the OT said the shift to “purely technology-based therapies” for her clients was “not always possible”, due to different patient abilities and access to technology.
“I mainly see two types of vision-impaired clients: the elderly people and children. Telehealth is not an option for a lot of these people,” she said.
She described it as a service that discriminated against not only the technologically disinclined, but people of low socio-economic status.
“There’s definitely lots of challenges with telehealth, some that are vision specific. Obviously people who are engaging with my provider have low vision or are blind, and it can be incredibly difficult or impossible to use technology.”
While technology offered “a lot of really cool opportunities” for the vision impaired, she said it “takes training to use and specialists to set up”, and it was an issue that was increasingly affecting older patients.
“A lot of elderly people don’t even have mobiles; they just have land lines. They don’t have Wi-Fi, let alone a computer, and this can be because they never grew up with technology and they don’t know how to use it,” she said.
“With older people, a lot of the time I’m just going over how to fix stuff, like their talking book machine is broken. That might not seem essential but if that is your entertainment in lockdown and it’s broken and you can’t watch television or do anything else, that’s your whole sanity. And I can’t fix the machine over telehealth.”
Patient inability to use the technology is one issue, and their economic position is another.
“A lot of clients are on disability pensions. They’re from low socio-economic backgrounds, and technology and Wi-Fi are expensive. It’s an issue that spans all telehealth services, not just vision-impaired clients.”
She said younger clients were more likely to find it easier to access telehealth.
“All the kids I see, their parents aren’t visually impaired. They’re more likely to have computers and Wi-Fi, and they have their parents to set up zoom and manage emails,” she said.
“The hard part with kids and telehealth is engaging them. How do you plan activities when you’re not physically with them? You can’t bring any of your equipment or games or craft stuff. None of your therapy items are there.”
She said practitioners “really have to get creative” with treatment activities for youth.
“We work around it with things like dropping supplies at their houses if they live close, but that disadvantages the kids that live further away.”
A perfect example of the difficulties faced by the OT using telehealth is a consult involving teaching a young boy how to dress independently, and tying his shoe laces is a component of this activity.
“Normally, you’d be guiding his hands, but [with telehealth] you’re giving only verbal instructions and it’s hard because I can’t really see what he’s doing because of his webcam.”
She said that physical consultations were not only superior in regard to the quality of therapy delivered, but in regard to the social needs of patients as well.
“For the people I see regularly it’s a social visit, too. They really enjoy seeing someone and having someone over because a lot of the older clients or the clients with multiple disabilities don’t leave the house very often.”
While she said in-person treatments remained a preference for her clients, the shift to telehealth was welcomed by some.
“Some people are fearful of in-person visits because of the virus. The clients are all vulnerable people who the virus would affect more severely, so it does provide a balance of safety with getting the services you need.”
She said online treatment was better than no treatment.
“I think if you can set up telehealth and it fits the client, they can use it and they are still benefitting from it, then it’s super important,” she said.
“Some therapies may seem like small or not essential services, but to the client having training on how to use your magnifier in lockdown makes the world of difference because then you can read, which helps you pass the time in lockdown or then you can pay your bills and the like.
“Telehealth kind of works, but you still feel like you’re not doing your job properly and people aren’t fully satisfied, which is not good for your self-esteem at work.”
Maia O’Connor