Could 'shared care' be the answer to Australia's health crisis?

Amid significant doctor shortages and growing patient demand, an Australian doctor is calling for a change in how the healthcare industry understands continuity of care.

Dr Andrew Thompson, Medical Director at telehealth service InstantScripts, believes Australia needs to shift to a ‘shared care’ model whereby patients see telehealth doctors when needed while continuing with their long-term GP for their overall health care.

The digital evolution of health care has been taking place amid GP shortages, Thompson said, noting that this shortage is proving a problem across the nation, particularly in the country, with around 20% of people in rural Australia unable to see a GP and around 50% unable to access specialists in their region.¹

“Against these interconnecting factors, maintaining a relationship with one doctor is unrealistic. In an increasingly digitalised healthcare environment, the answer to ensuring all Australians have quick and easy access to healthcare services while maintaining the quality of patient care is changing how we understand continuity of care.”

A new era of health care

An independent survey of 1000 Australians commissioned by InstantScripts found that just over 15% of Australian adults don’t have a regular GP, with just under half of those (48%) saying the lack of a chronic condition or need to visit a GP on a regular basis swayed their decision not to have their own doctor.

The research also found that, over a 12-month period, 94% of Australians have seen a GP just for a prescription or medical certificate. Digital health services, said Thompson, can be used to share these types of simpler services with people’s regular doctor, to help ease the workload of GPs.

“You don’t necessarily need to see your doctor in person just for a medical certificate or a prescription repeat. From this perspective, a shared care model just makes more sense.

“Digital platforms such as the MyGov ‘My Health Record’ provide GPs and health practitioners with quick and easy access to an individual’s medical history. The allows a patient’s regular doctor to remain informed of any treatments they receive elsewhere, providing a mix of both traditional continuity of patient care and more modern shared care practice," he said.

Changing our understanding of continuity of care

Continuity of care, as defined by the industry, is a continuing collaboration between a patient and one doctor over the long term to effectively treat and manage the patient’s health. Many industry professionals and bodies, including leading Australian Government health officials, advocate for this continuity of care model as it fosters trust, allows a GP to become familiar with a patient’s history, medications and health-related behaviours and attitudes, and results in positive patient experiences, greater satisfaction, better commitment to treatment and positive patient outcomes.²

However, the patient market and access to doctors have changed relatively quickly. “As a result of the COVID-19 pandemic, online health services have rapidly expanded as Australians are less willing to attend traditional healthcare premises to avoid contracting the virus. This rapid shift has facilitated an immense growth in this sector,” Thompson said.

From the onset of the pandemic, the percentage of Medicare consultations occurring via a telehealth service has increased from less than 1% to more than 25%. A vast majority of Australians are willing to use virtual services for health care and management, with 80% ready to share their personal health information on digital platforms.³

The shift in patient preferences

Survey data from InstantScripts shows 69% of Aussies would rather avoid having to see a GP in person in winter if they needed a medical certificate for sick leave. Almost two-thirds of respondents said they would use telehealth to obtain a medical certificate if access proved challenging.

One in five patients would prefer to see a GP that can fit into their schedule and is flexible, rather than the other way around. Specifically, the need to access a prescription in a hurry, an inability to leave home and feeling too unwell to visit their GP were the key drivers for at least half of Australian adults when asked what circumstances would prompt them to use a telehealth service.

In regional and rural areas, the need for a shared care model of healthcare delivery is more apparent, as patients are increasingly turning to online prescriptions and telehealth to fulfil their medical needs. One of the key findings to emerge from InstantScripts’ analysis of its own customer data is demand for its services outside of the metropolitan areas: InstantScripts saw a 313% increase in regional areas last year on 2020 and has already seen a further increase of 114% so far this year. Demand for services in regional areas currently represents approximately 34% of InstantScripts’ total business.

“These growth numbers are fuelled by GP shortages in country areas, but also the numbers of people departing from their usual GP or local medical centre in their migration to regional areas. Last year marked the first time in 30 years that Australia’s regional population increased more than the capital city populations, indicating a surge in the number of people moving away from crowded metropolitan areas, where the infectivity rate of disease is perpetually higher than in regional and rural localities⁴,” Thompson said.

One of the great things about digital health services is many are available to patients after hours, Thompson said.

“Technology should be used to our advantage and redefine the meaning of continuity of care to provide patients with the flexibility needed to see a doctor more regularly. The most useful model is user-centred technology powered by AI to enable all patients to easily book services and obtain records, and a team of real doctors to provide advice and navigate the health issues brought to them.

“Moving towards a shared care model will not only help relieve the pressure on GPs as they navigate inflated patient numbers amid doctor shortages, but allow Australians to continue receiving a high standard of care that meets their needs.

“Ultimately, shared care and continuity of care could go hand in hand, as long as telehealth services and traditional medical centres have a system in place to ensure an easy flow of transparent and clear patient information.”

^{1 University of Wollongong Australia, 2021 uow.edu.au/media/2021/new-medical-scholarship-to-address-shortages-of-rural-doctors-in-australia.php}

^{2 Australian Journal of General Practice, 2018, racgp.org.au/ajgp/2018/october/continuity-of-care}

^{3 Deloitte, March 2022, pg 5, deloitte.com/content/dam/Deloitte/au/Documents/life-sciences-health-care/deloitte-au-lshc-australias-health-reimagined-report-02032022.pdf}

^{4 ABS, March 2022, abs.gov.au/media-centre/media-releases/more-growth-regions-during-pandemic}

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