Changes in General Practice use and costs with COVID-19 and telehealth initiatives

Abstract

Background In response to the COVID-19 pandemic, general practice (GP) in Australia underwent a rapid transition, including the rollout of population-wide telehealth, with uncertain impacts on GP use and costs. Objective To describe how use and costs of GP services in Australia changed in 2020–following the pandemic and introduction of telehealth–compared to 2019, and how this varied across population subgroups. Method Data for ~19M individuals from Census 2016 were linked to Medicare data for 2019-2020 through the Multi-Agency Data Integration Project. We used regression models to compare age-sex-adjusted GP use and out-of-pocket cost (OPC) over time, overall and by sociodemographic characteristics. Results The number of people who visited a GP in Q2-Q4 of 2020 decreased by 4% compared to Q2-Q4 of 2019. The mean number of face-to-face GP services per quarter declined, while telehealth services increased, with overall use of GP services in Q4 2020 similar to or higher than Q4 2019. The proportion of total GP services by telehealth stabilised at ~25% in Q4 2020. However, individuals aged 3-14 or ≥70 years and those with limited English proficiency used fewer GP services in 2020 compared to 2019, with a lower proportion by telehealth. Mean OPC-per-service was lower across all subgroups in 2020 compared to 2019. Discussion Introduction of widespread telehealth largely maintained use of GP services during the pandemic and minimised OPCs, but not for all population subgroups. This may indicate technological, social or other barriers in these populations, as well as pandemic-related changes in healthcare use. Key words: Telehealth, COVID-19, primary care, out-of-pocket costs, linked data

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported by a grant from the RACGP Foundation and HCF Foundation and a Medical Research Futures Fund Grant (Grant no. 2006309).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Human Research Ethics Committee of the Australian National University gave ethical approval for this work (2020/577).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

Data part of the Multi-Agency Data Integration Project are available for approved projects to approved government and non-government users. https://www.abs.gov.au/websitedbs/D3310114.nsf/home/Statistical+Data+Integration+-+MADIP

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