Virtual healthcare models, like ‘hospital in the home’, are garnering widespread support from Australians, with up to 94 percent expressing their intent to attend a virtual appointment in the future.
Despite their popularity, Dr Shaun Hosein of Queensland Health – a speaker at this year’s Hospital in the Home Conference – believes complacency around the model could be dangerous.
Ahead of the conference, he highlights concerns around remote patient monitoring (RPM) technologies, the tele- and video-health medium, and vulnerable patient cohorts.
#1 – Video- and telehealth isn’t always suitable
While Dr Hosein generally advocates the use of virtual care, he says the competencies required to deliver a quality service should not be underestimated. Nor should they be assumed to be intuitive.
“Clinicians need to be skilled at managing patients in the virtual realm, which covers the full communication spectrum – from face-to-face, to video, to the old fashioned phone.
“They also need to understand which modality is needed and when. All virtual health practitioners should know the limits of their practice and the medium they are using to ensure safe and high quality care.
“Of course, many clinicians have these skills and knowledge, but we can’t assume that everyone does. Many may require dedicated training and experience,” he said.
#2 – Governance around RPM tech needs consideration
RPM devices, like smart watches, have long been supporting patients’ decision making around their health. However, in the clinical domain, Dr Hosein is concerned some tools may be too sensitive.
“Sometimes, they pick up normal events – like a high heart rate that a patient may have had their entire life – which have no clinical relevance, but which might prompt medical intervention. The knock on effect of this of course being wasted resources,” he said.
To combat this, he believes RPM tools should always be used in conjunction with patient education.
“We have seen great results with diabetic blood sugar monitors, where consumers have been empowered to use them appropriately – and I think that is something we need to see for all take-home devices,” he said.
Additionally, use of these devices should ideally be in shared care with trained health professionals.
“Clinicians should help guide and empower patients along their health journey, not extend a culture of dependence,” Dr Hossein added.
#3 – Some patients should be seen face to face where possible
Telehealth has been widely adopted in residential aged care facilities (RACFs), where after-hours usage has already driven substantial reductions in ED visits.
Despite this, Dr Hosein believes, RACF consumers may be better suited to other healthcare mediums in some instances.
“If the consumer just wants a script for their blood pressure medication, then a virtual consult is probably fine, but there are many other times where they may need to go in and been seen face to face. Telehealth can certainly streamline healthcare, but it isn’t always optimal, especially for vulnerable patient groups,” he said.
Where an in-person consult is preferred, but telehealth is the only reasonable option, Dr Hosein recommends a deeper look at how the medium can be optimised.
“We need to explore better ways of assessing patients and providing a more streamlined journey, so that people feel they have better options than calling an ambulance and going straight to emergency for a low-acuity issue.”
Dr Hosein also cautions against the growing push towards ‘hospital avoidance’ – a popular argument for telehealth – and believes the term is not always as positive as intended.
“If a patient truly does not need to be seen in-person and telehealth is diverting people from unnecessary ED visits, great. If better outcomes are being missed out on, in favour of convenience or cost-cutting, not so great,” he said.
Dr Shaun Hosein is a Senior Medical Officer for the Hospital in the Home service at the Sunshine Coast Hospital and Health service.
He was the Medical Director of the service since Aug 2021, but recently stepped down to pursue the development of virtual health with the Queensland Ambulance Service.
He is a generalist, previously working in rural remote Australia, and holds both a FRACGP and FARGP (Aged Care) fellowship with RACGP.
Hear more from Dr Hosein at the upcoming Hospital in the Home Conference, hosted by Informa connect.
The conference is one of three to be delivered at Connect Virtual Care on 7-8 March 2024 at the Hilton Sydney.
Co-located at the event are the National Telehealth Conference 2024 and Medication Safety and Efficiency Conference 2024.
Learn more and register your place here.