Telehealth - what is it all about?

With social distancing being the dominant strategy nation-wide for the minimisation of spread of COVID-19, the ongoing pandemic is seeing more and more people being advised to ‘stay at home’ and to take work home wherever possible.

Whilst the older population and those with chronic health conditions or impaired immune systems are fundamentally our main health concern when talking about COVID-19, this is not to say that other health conditions or populations should be ignored.

There is in fact a highly effective form of ongoing access to health care which many people simply aren’t aware of, and some who are aware of it don’t know what’s really involved.

We are talking about ‘telehealth’ – something that’s been around for years and which has been utilised with proven beneficial outcomes (1-3) in keeping people healthy and delivering access to injury assessment and rehabilitation.

What is telehealth?

Telehealth is a means by which health and medical services can be provided through the use of telecommunication technology such as online video-conferencing or telephones (with or without video), in lieu of the traditional face-to-face in person.

Much the same as it would be in normal consulting rooms at clinics or hospitals, patients can discuss their condition, have it assessed and diagnosed, and have appropriate treatment and rehabilitation initiated and maintained using ‘online’ consultations.

Research has demonstrated the effectiveness of telehealth for over 10 years in treating musculoskeletal, neurological, paediatric and women’s health conditions (4-6) and with rapidly improving technology, the delivery of expert care is becoming both more advanced and more accessible to people from all regions.

With the current enforcement of social distancing, and the genuine potential health risks posed to certain ‘at risk’ groups, telehealth is now becoming an increasingly common and important means of allowing the general public to continue accessing essential health care.

What are the benefits of telehealth?

Assessment and diagnosis

Clinicians can glean a lot of information about a patient’s condition by obtaining a thorough history of how symptoms began and any specific symptoms they may experience, along with watching how they move and getting them to perform some specific physical tests.

Injury management

A specific rehabilitation plan can be devised with every patient, including exercise and education around why a certain condition may have developed and modifications that can be made to empower self-management.

Referrals and test results

With ready and secure online access to clinic medical files and radiology facilities and pathology laboratories, clinicians can review results, refer for scans or pathology test and refer patients to other specialists with ease if required.

Equally, clinicians can access the reports of any imaging or surgery patients may have had.

Exercise prescription

Our practitioners can prescribe individualised home exercise programs to prevent deconditioning while patients are perhaps out of their normal work, sport or gym program.

This will reduce the likelihood of new injuries when patients return to their chosen activities.

Managing chronic conditions

With almost all non-urgent elective surgery being postponed at the moment to preserve protective equipment and free up hospitals and staff for potentially ill COVID-infected patients, we can help you with non-surgical strategies to manage and improve your symptoms in the interim, and get you physically prepared (‘prehabilitation’) for when surgery resumes.

Decision making

If you’re unsure about how to best manage an injury (eg. ACL rupture), we can talk you through an evidence based process of shared decision making to help you decide the best course of management for your injury (eg. surgical vs non-surgical treatment).

Shorter waiting times

It’s actually quicker than normal at the moment to get an appointment with a usually fully booked health professional.

People are hesitant to venture outdoors currently, even for essential healthcare, and this is where telehealth can be a major advantage.

Getting assessed by your doctor or podiatrist or starting physio now can improve your likelihood of helping you get back to work and fully recovering in time for when sporting seasons ultimately resume.

When telehealth is performed from the home environment, many practitioners can also offer flexibility with fitting consultations in around various other patient or clinician commitments.

This is a great opportunity to get on top of niggles you’ve been dealing with for a long time.

Exercise classes

Keep strong and keep symptoms at bay by continuing your GLA:D or clinical exercise/Pilates classes with your regular practitioner who knows your body.

Good alternative

If you’re unable to physically attend a physiotherapy or sports medicine appointment, telehealth sessions are definitely a good option, and certainly much better than no treatment for continuing your rehab and preventing recovery delays.

Complementing in person visits

Some conditions do need face to face or hands on assessment or treatment and there’s no way around it.

Telehealth can however be useful for follow up sessions to discuss treatment options, review of results or checking up on technique with home exercise programs and symptom management between in-clinic sessions.

Removing geographical barriers

It doesn’t matter where you live, you can still get access to expert medical and allied health services from clinicians who are some of the best in their field.

This can be greatly beneficial for people living in rural and remote areas, but can also save people living in metropolitan areas lots of time wasted in traffic.

As an added advantage, the current surge in telehealth will likely prove a game changer in wider access to expert health services once the COVID-19 situation resolves.

Is Telehealth safe? How does it actually work?

Technologically

There are numerous easily accessible options to keep your information private while conducting telehealth (eg. Zoom, Coviu, Physitrack and a plethora of others).

These platforms are well security encrypted which is a priority for our clinicians.

You will be sent simple to follow information about how to access these platforms prior to your appointment.

Your consultations are not recorded, much as we would not record in-clinic consultations.

We can also send your exercise programs via email with video reminders of exercise technique and dosage.

Test results, radiology reports and referrals for investigations or seeing other specialists can also be delivered safely online.

Physically

While your clinician won’t be able to feel or assess your injury with their hands on telehealth, they will still have their highly experienced eyes, ears and clinical brain working during your consult in the same way they would be in the clinic.

Research has proven telehealth to be a very effective form of assessment and treatment.

If clinicians have any concern regarding your injury or progress they will still be able to refer you for investigations, and in some cases may recommend an in-clinic consult either with themselves of with another clinician providing in person consults.

Can I do my normal exercise class with telehealth?

Yes, most physiotherapists at the clinic have moved their popular clinical exercise/Pilates and GLA:D knee + hip osteoarthritis exercises classes to the online format.

This still allows your physio to demonstrate specific exercises, watch and correct your technique, and allow the fun social element of class to continue.

As your physio knows you and your injury well, it’s much safer than a following a generic you-tube exercise class.

What does it cost?

Just as the various community restrictions imposed keep rapidly changing with the current COVID-19 pandemic, so to does the structure of health care services and their reimbursement rates.

The Department of Health continue to revise rebates and fee structures for medical and allied health services and will likely continue to do so for some time.

At the present time, private health insurance can be used for rebates on physiotherapy telehealth consultations (not including classes), and patients may be eligible for Medicare bulk billed telehealth consultations if they have a current care plan from their GP or meet various other criteria.

Medical consultations can continue in the majority of cases to utilise specific Medicare rebates for telehealth consultations. In certain instances, our clinicians are not able to bill their usual full fee and will be accepting a reduced fee overall for their services during this challenging time.

Patients funded by WorkSafe, TAC or DVA should contact the clinic to check their eligibility for telehealth funding, and in a continually changing environment, ultimately we encourage all patients to speak to reception staff about what to expect with billing arrangements according to the various rebates available.

Rhiarna Hill is a Titled Sports and Exercise Physiotherapist, Dr Stuart Down is a Specialist Sport & Exercise Medicine Physician.

Lifecare Prahran Sports Medicine is close to suburbs including Malvern, South Yarra, Toorak, Armadale, St Kilda East, Caulfield, Richmond and Hawthorn, and has early and late appointments for all your Sports Medicine and Physiotherapy needs

References

1. Castro D, Miller B, Nager A. Unlocking the Potential of Physician-to-Patient Telehealth Services. The Information Technology & Innovation Foundation; 2014. https://itif​.org/publications​/2014/05/12​/unlocking-potential-physician-patient-telehealth-services. Accessed Nov 15 2018.
2. Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington, DC: The National Academies Press; 2012.
3. Bashshur RL, Shannon GW, Smith BR, et al. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health. 2014;20(9):769–800. doi: 10.1089/tmj.2014.9981. PMID: 24968105.
4. Grona SL, Bath B, Busch A, Rotter T, Trask C, Har- rison E. Use of videoconferencing for physical therapy in people with musculoskeletal conditions: a systematic review. J Telemed Telecare. 2018;24:341- 355. https://doi.org/10.1177/1357633X17700781
5. Burke BL Jr, Hall RW; Section on telehealth care: Telemedicine: Pediatric Applications. Pediatrics.2015 Jul;136(1):e293-308. doi: 10.1542/peds.2015-1517.
6. Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes: A Systematic Review, DeNicola, Nathaniel MD et al. Obstetrics & Gynecology: February 2020 – Volume 135 – Issue 2 – p 371-382 doi: 10.1097/AOG.0000000000003646