Temporal changes in chronic disease management in primary care in relation to telehealth policy changes: Australian whole-of-population interrupted time-series analysis.

Abstract (English)

BACKGROUND: Universal telehealth aims to support access to timely coordinated chronic disease care. Large-scale evidence on the extent to which this occurs to guide telehealth policy is limited. OBJECTIVE: To examine temporal changes in uptake and timeliness of general practitioner chronic disease management (GP-CDM) services in Australia following universal telehealth introduction (March 2020) and removal of subsidized telephone (but not video) GP-CDM services (July 2021). METHODS: Whole-of-population cohort study of linked national claims and death data, 2018-2022. Interrupted time-series analyses quantified temporal changes in GP-CDM service uptake and timeliness following telehealth policy changes. RESULTS: From 2018 to 2022, each month an average of 568 858 GP-CDM services were delivered, with 25-43 users and 44-76 services per 1000 population aged 45-<85 per month. After universal telehealth introduction, GP-CDM uptake remained stable, with similar trends pre- and early-pandemic. Monthly uptake decreased substantially following the removal of telephone GP-CDM services [decrease of 4.0 users (95%CI -6.3, -1.7) and 6.9 services (-10.5, -3.3) per 1000 population]. In the first month of telehealth, 38.7% of people using GP-CDM services used telehealth (37% telephone, 1.7% video), declining to 2.2-5.4%/month after removal of telephone GP-CDM services. Small improvements in GP-CDM timeliness stalled once telephone services were no longer available. Patterns were similar across population subgroups. CONCLUSIONS: Telehealth policies in Australia sustained access to chronic disease care during the pandemic. Limiting access to these services to video alone was associated with a greater than expected decline in use had the pandemic and introduction of telehealth not occurred.