To the Editor: In the 16 October 2023 issue of the Medical Journal of Australia, Foo and colleagues1 described the exponential rise of direct‐to‐consumer (DTC) telemedicine services operating outside of Medicare and listed a sample of almost 80 services. Criticisms of DTC telemedicine were flagged, including the potential to exacerbate health inequities, risks to quality and safety, and fragmentation of care. Important areas for future research were also identified, given gaps in evidence to inform policy and practice.
Here we highlight findings from three projects2,3,4 conducted in 30 remote First Nations communities in Australia: one project assessed consumer and provider digital health care preferences and two projects determined consumer preferences for access to primary health care services.
A core issue identified by consumers was the importance of relationships, which enabled continuity of care; that is, seeing the same person over time who comes to understand the local social, cultural and economic context. In one First Nations community in Central Australia,4 both consumers and providers strongly preferred telemedicine consultations to occur at their local clinic with a local health professional present. The important reasons for this preference were that the presence of a local health professional who has a long term relationship with the patient helped them feel comfortable and supported, and reduced cultural, language and health literacy barriers.
Long term trusting relationships between consumers and their doctors are at the heart of general practice. Although Foo and colleagues1 acknowledged that DTC telemedicine patients often do not have an existing relationship with providers and the anecdotal nature of the relevant evidence, the authors failed to adequately address continuity of care in their recommendations. We therefore propose that future DTC telemedicine research should investigate impacts on continuity of care and on existing general practitioner workforce maldistribution and general practitioner shortages,5 including unintended workforce consequences (DTC telemedicine could reduce the effectiveness of medical workforce redistribution policies, such as section 19AB of the Health Insurance Act 1973, as opportunities for doctors to work outside of Medicare expand). This future research includes exploring numbers, work patterns and effectiveness of the DTC telemedicine workforce to adequately inform medical workforce planning and ensure that face‐to‐face services are available where they are needed most.
- 1. Foo D, Spanos S, Dammery G, et al. The rise of direct‐to‐consumer telemedicine services in Australia: implications for primary care and future research. Med J Aust 2023; 219: 344‐347. https://www.mja.com.au/journal/2023/219/8/rise‐direct‐consumer‐telemedicine‐services‐australia‐implications‐primary‐care
- 2. Fitts MS, Humphreys J, Dunbar T, et al. Understanding and responding to the cost and health impact of short‐term health staffing in remote and rural Aboriginal and Torres Strait Islander community‐controlled health services: a mixed methods study protocol. BMJ Open 2021; 11: e043902.
- 3. Mathew S, Fitts MS, Liddle Z, et al. Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face‐to‐face consultations? BMC Health Serv Res 2023; 23: 1‐10.
- 4. Digital Health CRC. Optimising digital solutions to improve access to comprehensive Primary Health Care services in remote Indigenous communities [website]. Australian Government Department of Industry, Science and Resources, 2023. https://digitalhealthcrc.com/projects/optimising‐digital‐solutions‐to‐improve‐access‐to‐comprehensive‐primary‐health‐care‐services‐in‐remote‐indigenous‐communities/ (viewed Dec 2023).
- 5. Russell DJ, Monani D, Martin P, Wakerman J. Addressing the GP vocational training crisis in remote Australia: lessons from the Northern Territory. Aust J Rural Health 2023; 31: 967‐978.
We acknowledge contributions of investigators, project partners and members of the project governance groups for two projects: Optimising digital solutions to improve access to comprehensive Primary Health Care services in remote Indigenous communities; and Understanding and responding to the cost and health impact of short‐term health staffing in remote and rural Aboriginal and Torres Strait Islander community‐controlled health services. We also sincerely thank the Boards of Directors and staff of participating health services and consumers in communities we visited who shared their stories. The first project is supported by the Digital Health CRC Limited (DHCRC), which is funded under the Australian Commonwealth's Cooperative Research Centres (CRC) Program. The second project received funding from the Australian Research Council's Discovery funding scheme (project number DP190100328) and the Medical Research Future Fund, Rapid Applied Research Translation 2.2.2019/MRF9100008; Central Australian Academic Health Science Network. The information and opinions contained in it do not necessarily reflect the views or policy of the Commonwealth of Australia (or the Department of Health).
No relevant disclosures.