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GPs at the forefront of South Australia’s successful efforts to tackle coronavirus
The state has been among the nation’s leaders in controlling the virus – here’s how.
Three quarters of all coronavirus patients managed by GPs in the community.
The creation of a GP rapid response team within a week to care for patients with mild SARS-CoV-2 symptoms at home through telehealth.
Training and protocols created in a matter of days to allow GPs in the response team to care safely for patients.
GPs embedded in decision-making about the COVID-19 pandemic, working alongside the state health department, Primary Health Networks (PHNs), the RACGP and the Australian Medical Association (AMA).
Tests created rapidly by a state-owned pathology organisation, allowing GPs to test for the new virus alongside the flu in early February – using the same swab to conserve scarce resources.
Welcome to South Australia’s conquering of the coronavirus, with GPs very much at the forefront.
Of the state’s 439 cases, 334 were cared for by GPs in the state’s COVID-19 GP assessment team, run by GenWise.
SA Health GP liaison officer Dr Emily Kirkpatrick – who is also the Deputy Chair of RACGP SA&NT –told newsGP she was surprised and pleased at how well her state dealt with the virus.
‘Having three quarters of our patients managed here in the community has been key. It’s quite a big difference from the other states,’ she said. ‘We haven’t really talked about it, but it’s quite remarkable.
‘It was an entirely GP-run model.
‘I am pleasantly surprised with how well it’s gone and how much we’ve been able to achieve in South Australia. I don’t think we could have expected such a positive outcome with such high-level collaboration.’
The last patient in South Australia who had COVID-19 left hospital last week to applause from medical staff at the Royal Adelaide Hospital.
A week earlier, on 15 May, SA Health declared there were no active casesremaining in the state of 1.7 million people, with no new cases since 7 May.
The state is now beginning to reopen – ahead of schedule – with Premier Steven Marshall claiming his state had led the nation in its response to the virus.
Here’s how South Australia did it.
COVID-19 GP assessment team
The state’s chief public health officer, Professor Nicola Spurrier, decided early that it was important to have a GP liaison in order to engage directly with GPs on the community frontline.
‘It’s because of that we could set up the assessment team – we couldn’t have achieved it without that [GP liaison] role,’ Dr Kirkpatrick said.
‘We’ve put forward our intention to continue greater GP engagement at SA Health even after the pandemic, which is great.’
The assessment team was launched on 24 March, after just seven days of intense preparation.
The team was initially set up to help each patient’s usual GP manage the virus. But as numbers started to rise, it became clear that additional training was needed due to the complexity of the situation. The assessment team began conducting all coronavirus community care by 30 April.
Potential coronavirus patients were tested either in a drive-thru clinic by SA Pathology nurses, or in a hospital COVID-19 clinic.
‘That was the only time they would come out of the house if they had mild symptoms. The rest of the time they were at home and GPs and nurses checked on them every day,’ Dr Kirkpatrick said.
If a person was found to be carrying the virus, the GP assessment team – in conjunction with the SA Health public health unit – determined if it was safe to treat the patient in the community.
‘We had a team of 35 GPs, and we had quite a number of positive patients at the time,’ Dr Kirkpatrick said. ‘We assessed all of them, regularly reviewed them, and cleared them at the end.
‘GPs decided if they could stay home or had to go to hospital, supervised by the SA public health team.’
GPs helped coronavirus patients access food, social supports and mental health services while maintaining strict home isolation. Patients were asked to stay in their own separate area within the home, if they lived with other people, and avoid any contact.
‘It was all done virtually, after a very extensive risk assessment,’ Dr Kirkpatrick said. ‘Children had to be seen face-to-face or by video with a paediatrician, with adults receiving a phone call or video.’
Strong connections with hospitals led to processes for escalation of care in the event the disease progressed. Only two patients in the community had to be escalated to hospital.
‘It was remarkable how well people did in their own home,’ Dr Kirkpatrick said.
Testing started early, with tests created in-house
South Australia had its first two cases early on, after a couple arrived from Wuhan in January.
The cases were confirmed by 1 February.
‘We had a couple who were travellers from Wuhan. They were admitted to the Royal Adelaide Hospital – and that made us really think about the testing platform and our capabilities,’ Dr Kirkpatrick said.
‘That was one reason we moved so quickly.’
SA Pathology had created its own tests by 6 February, allowing GPs to test for the coronavirus alongside the flu.
‘Novel coronavirus testing will become part of routine respiratory infection testing, resulting in a more efficient and streamlined process for GPs,’ SA Health said in a statement at the time.
‘While it will result in more South Australians being tested, it will mean more people will be able to rule out any links to novel coronavirus.’
That made South Australia the first state to allow GPs to routinely test for the coronavirus – even as other states grappled with shortages of swabs, requiring GPs to only test patients who fit a narrow set of criteria.
‘We didn’t have to rely on tests from interstate. It was done in-house so we could very quickly add that on to the respiratory panel and allow GPs to order it,’ Dr Kirkpatrick said.
The fact that SA Pathology was government-owned made it easier to respond rapidly.
‘They have been the sole provider of COVID-19 testing until the last couple of weeks. They carried us for three months,’ Dr Kirkpatrick explained.
How could they respond so quickly? Because South Australia had been ramping up its flu testing capabilities in recent years.
‘SA Pathology has been heavily involved in the respiratory pathogen space previously, involved in the Australian Sentinel Practices Research Network [ASPREN] based at the University of Adelaide, so they had the expertise in-house to be able to develop the COVID-19 platform, while other pathology companies had to rely on buying kits,’ Dr Kirkpatrick said.
‘While many other labs were struggling with swab supply, we could run the respiratory viral pathogen PCR and SARS-CoV-2 PCR tests off the same swab, which was a real advantage. It meant we could conserve our swabs.’
South Australia’s rate of testing is the third highest in the nation, with 46,000 tests per million population.
SA Health ran weekly webinars with their own experts – as well as RACGP, AMA and PHN input – where cases could be discussed.
Dr Kirkpatrick sent newsletters to the state’s GPs from Monday to Friday, with the latest information and GP-relevant tips. Her work has been hailed by her peers, including her predecessor in the liaison role, former RACGP SA&NT Chair Dr Danny Byrne.
Dr Byrne told newsGP Dr Kirkpatrick successfully connected the public health unit to private general practice.
‘This [newsletter] service has been highly regarded by GPs on the ground,’ Dr Byrne said.
‘SA Health realised early on they needed a GP in the COVID-19 space to work alongside [its own] staff. Emily has done amazing work.’
In addition, SA Health set up two coronavirus dashboards – one public and one for medical use.
‘The medical dashboard had really accurate data on how long patients had been infectious for, how long their symptoms lasted and when they were cleared,’ Dr Kirkpatrick said.
‘We could see hospital capacity – every bed in the state – as well as how many tests had been done that day, how many new cases, as well as maps of where testing was being done, so you could see any gaps.’
Into the future
GPs have been calling for more input into disaster management and planning for years.
In the aftermath of this summer’s bushfires – and as the current pandemic continues – South Australia may be showing the way.
‘When it comes to disaster planning, we really need to refocus on what primary care can deliver,’ Dr Kirkpatrick said.
‘Some people thought GPs wouldn’t want to manage the coronavirus, but it was the opposite – we had too many. There was so much interest from GPs who wanted to be part of the process, it was remarkable.
‘Having such high-level collaboration, with the RACGP, PHNs, AMA and SA Health working as one cohesive group, it hasn’t been achieved before.
‘We can’t waste this opportunity. We have to take forward all these lessons learned and take it all with us.’
How did the response unfold?
An SA Health spokeswoman provided newsGP with a brief timeline of the state’s response to the coronavirus:
22 January – First Public Health Alert disseminated to GPs
1 February – First two positive cases
6 Feb – First local testing at SA Pathology
10 March – Announcement of nation’s first drive-thru COVID-19 test collection centre
17 March – Announcement of South Australia’s first regional COVID-19 clinic
22 March – Border closure announcement
24 March – First community transmission
25 March – First ICU cases
26 March – Biggest increase in cases (38 cases)
28 March – Announcement of further measures to reduce the spread
1 April – Announcement of additional staff for contact tracing
7–12 April – All four deaths
15 April – Announcement of testing blitz
17 April – Announcement of rapid COVID-19 testing
17 April – Announcement of wastewater testing
23 April – Announcement of home hospital program
24 April – Announcement of digital prescriptions
30 April – Announcement of COVID-dedicated teams of GPs and nurses for people self-isolating
6 May – 14 days of no cases
7 May – One new case
18 May – Announcement of asymptomatic testing
21 May – Last COVID-19 patient leaves ICU
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Expanded access to telehealth could continue after pandemic
A spokesperson for Federal Health Minister Greg Hunt has said he is engaged in planning a ‘long-term future’ for the newly funded service.
According to the Sydney Morning Herald, around 4.7 million people have received 7.7 million telehealth services since 13 March, while a recent RACGP survey has found 99% of practices are now able to facilitate telehealth consultations.
The Federal Government is reportedly ‘actively monitoring’ how the new telehealth services are working, after they were hastily implemented within just two weeks.
A spokesperson for Federal Health Minister Greg Hunt said more than 67,000 providers across all medical specialities have used telehealth services to date, and that he has lobbied for telehealth to continue after the coronavirus pandemic.
‘Minister Hunt is already engaged with the medical community and other key participants in planning a long-term future for telehealth,’ the spokesperson said.
‘Clinical efficacy and safety, patients’ and providers’ experiences, and assessment of quality and value of services will be considered.’
Recent data gathered from 1000 general practices in NSW and Victoria by Outcome Health found telehealth already comprises 40% of all consultations, and is expected to overtake face-to-face appointments in the near future. The vast majority of telehealth consultations were conducted over the phone.
RACGP President Dr Harry Nespolon said GPs have worked ‘incredibly hard’ to adapt how they consult with patients and he welcomed the results of the college’s survey.
‘I am mindful that many GPs may not have participated in telehealth video consultations or telephone consultations before. So it is wonderful news that they have changed the way they operate in these trying times to implement these changes and look after their patients,’ he said.
‘The reason the RACGP pushed so hard for the Federal Government to expand subsidised telephone consultations is that it is a technology that everyone has and will help limit the spread of COVID-19.
‘By adopting telehealth and telephone consultations, in addition to face-to-face consultations, [GPs] can take care of their patients and limit the transmission of COVID-19 in our communities.’
The RACGP survey of more than 1180 Australian GPs also found that while nearly every practice is offering telehealth, the vast majority – almost 97% – are still offering face-to-face consultations as well.
Data collected by Outcome Health shows overall GP contacts and prescriptions have remained steady, but there has been a significant drop in pathology and radiology prescribing.
Dr Nespolon said it is important practices remain open for in-person consultations, especially as the college is encouraging patients to continue seeing their GP through the Expert Advice Matters campaign.
‘It’s very concerning that some people have potentially been avoiding or delaying consultations during this pandemic and that is why we launched our GP expert advice campaign,’ he said.
‘There are of course some health concerns that can’t be taken care of over the phone and require a consultation in person, so it is great to see that almost all GP clinics are offering face-to-face consultations too.’
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Australia must learn to live with coronavirus: Infectious disease expert
The virus will be part of our lives until an effective vaccine arrives – because elimination is ‘very unlikely’.
That is the view of infectious disease specialist and microbiologist Peter Collignon, a professor at the Australian National University and former World Health Organization (WHO) advisor.
‘New Zealand is aiming for elimination and Victoria is trying to emulate that. But I think that’s very unlikely,’ Professor Collignon told newsGP.
‘There are so many mild or asymptomatic cases that we can’t find them all. I don’t think we’re going to stop it, but we can keep it to really low numbers.’
These comments come as countries around the world plan a staggered return to normality, depending on their infection rates.
Professor Collignon has outlined an approach he believes could restore a version of familiarity, as states and territories around Australia look to progressively reopen. These steps include:
testing sewage for the virus to get early warnings of a new outbreak
using newer testing methods and sentinel testing to find clusters, track contacts and isolate people with the virus
maintaining hand hygiene and droplet control, given droplets seem to be the main transmission vector
considering the introduction of face shields for all public-facing staff in order to reduce the risks of both passing or receiving the virus.
Learning to live with the coronavirus will be essential, as Australia is likely to enter the ‘long tail’ of the virus with community transmission dampened but clusters still emerging.
The Federal Government’s new COVIDSafe app is intended to enable the progressive reopening of society, by allowing state and territory health departments to more easily track contacts of people with the virus.
‘Elimination is not very likely, but we can achieve low levels of transmission and do that without lockdowns,’ Professor Collignon said. ‘That can mean less isolation and cabin fever.’
Though the coming winter’s expected rise in cases could be a challenge, Professor Collignon predicts that any second wave will likely be smaller than the first.
‘As our first was due in large part to cruise ships and overseas travellers returning,’ he said.
Nations like the Netherlands and France are now employing sewage testing as a way to catch new outbreaks.
‘Sewage testing is a good early warning system to tell us if we need to tighten up restrictions,’ Professor Collignon explained.
‘Sixty per cent of people with the virus excrete it, so you can see it rising before there are increased cases in hospitals.
‘We may also need to think about face shields in the community for medical workers and anyone who can’t avoid getting close. Face shields have the advantage that if people have droplets [sprayed on them], it goes on the shield. It also reduces the chance of touching your face. And if people are presymptomatic and they cough, it is caught inside the shield.
‘You can wear them for hours, whereas masks are uncomfortable and don’t protect your eyes. You can clean them and decontaminate face shields.’
To date, Professor Collignon believes Australia has done well balancing the economic destruction of the shutdowns against the risks the virus poses to health, by employing a less stringent lockdown than New Zealand while also avoiding the dangers of the Swedish hands-off approach.
Sweden’s decision to leave most of the economy open has contributed to a death rate almost 70 times higher than Australia’s on a population basis, with 262.1 deaths per million compared to Australia’s 3.8. However, other nations that entered lockdown also have rates as high or higher than Sweden.
‘I would not recommend the Swedish approach. Their death rate is many times higher than Australia and they haven’t had a large percentage of their population become immune,’ Professor Collignon said.
Australia’s decision not to enter a stringent stage four lockdown as New Zealand did – requiring almost everyone to be housebound – has been vindicated by the fact both countries have all but flattened the curve, Professor Collignon said.
‘We took a relatively severe approach, with a million people out of work,’ he said. ‘But we haven’t had the same lockdown as New Zealand.
‘And I’d argue we don’t have to, because we don’t have uncontrolled spread. A complete lockdown is appropriate when you have no control over the situation, as in the UK or New York.’
Professor Bruce Thompson, Dean of Health at Swinburne University told newsGP that the fact Australia was considering re-opening without eliminating the virus meant we would have to live alongside it until an effective vaccine was available.
‘We have to start working on a society where we have these viruses alongside us, while containing them,’ he said.
Professor Thompson said living with low levels of coronavirus would mean society would have to change, such as challenging the expectation that it was acceptable for someone with a minor illness or fever to come to work.
University of Adelaide Professor of General Practice Nigel Stocks told newsGPthat his sentinel testing network of GPs is preparing to begin testing symptomatic people aged 20–49 as early as next week, pending ethics approval.
With more 300 GPs participating around Australia, the Australian Sentinel Practices Research Network (ASPREN) is expanding focus from tracking influenza and other respiratory viruses to begin the hunt for hidden cases of the coronavirus.
But Professor Stocks said the effectiveness of social distancing will make broad-scale sentinel testing more challenging.
‘The difficulty is that SARS-CoV-2 is now quite a rare virus [in Australia],’ he said. ‘You would expect more cases to be arising if it was common and asymptomatic. Can it hide that well? Or is it gone?
‘Unless you have the capacity to ramp up sentinel testing, it’s not as effective for rare illnesses because you just can’t cover everyone or every location.’
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RACGP releases COVIDSafe fact sheet
The resource is designed to help GPs communicate to patients how the app works, why it is safe, and what they can do to help combat the coronavirus.
The recently released app is designed to aid contact tracing efforts ahead of a potential easing of lockdown restrictions, but has been met with reservations from some in the community regarding its effectiveness and how it handles and uses private information.
In response, the RACGP – which previously came out in support of the app – has now released a COVIDSafe Fact Sheet aimed at providing accessible and straightforward information to patients.
More than four million people have already downloaded the app, but it is still well-short of the around 40% coverage of the population required in order for it to become effective.
A recent Ipsos survey of 2000 Australians found that while 54% somewhat supported or strongly supported the app, 37% were opposed, with privacy cited as the overwhelming concern (79% of those opposed).
RACGP President Dr Harry Nespolon said the new fact sheet will help clarify details of the app that are leading to confusion and alarm for some members of the community.
‘This pandemic is forcing us to adapt the way we live our lives and go about our day-to-day business,’ he said.
‘I understand that asking people to download an app helping to track cases of a potentially deadly virus can cause some anxiety. This isn’t something that we have had to do before and some people may not have much experience downloading and using apps.
‘You may have heard a lot of technical language being used in the media concerning this app and its capabilities. This fact sheet avoids all of that – it’s designed for everyone to read and share with their friends and family.’
Aside from explaining that the app helps mitigate the risk of outbreak through tracking cases of the virus in the community, the fact sheet also provides technical information on how it achieves such a result.
‘Basically, if you come into contact with others who are using it, a “digital handshake” occurs,’ Dr Nespolon said.
‘This information is securely stored on your own phone and is not accessed by anyone else unless a person is diagnosed with the virus and they consent to uploading the contact information collected to a highly secure information storage system.’
Other nations, such as South Korea, have used similar technology to successfully reopen parts of society previously shut down by the coronavirus, and Australian Prime Minister Scott Morrison recently said any move to ease coronavirus restrictions will be contingent on ‘millions more’ registering.
With the national cabinet set to meet again on Friday to deliberate changes to the lockdown, Dr Nespolon agrees it is vital more people download the app immediately.
‘Please encourage your family members, friends and work colleagues to download the app. If they express concerns about security or privacy, point them to this fact sheet,’ he said.
‘Also perhaps remind them that the more people who use COVIDSafe the more effective it will be. If there is a high number of downloads we will get closer and closer to removing the social restrictions in place and getting our communities back to normal.
‘As I have been saying to my patients, these are anxious times, but we are all in this together. We all have a role to play in combating this once-in-a-lifetime pandemic.’
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General practice accreditation process on hold
Requirements to renew accreditation under the National General Practice Accreditation Scheme have been updated.
‘As far as the Commission is concerned, there’s no pressure on anyone to engage in any specific accreditation activities and PIP [Practice Incentives Program] payments are ongoing.’
That is the message Dr Louise Acland, Chair of the RACGP Expert Committee – Standards for General Practices and Co-Chair of the General Practice Accreditation Coordinating Committee for the Australian Commission for Safety and Quality in Health Care (the Commission), wants to make loud and clear.
Recognising the pressures on GPs as central players in the pandemic response, the Commission has updated the National General Practice Accreditation (NGPA) Scheme requirements.
As of 25 March, all accreditation to the RACGP’s Standards for general practices(5th edition) (the Standards) will be maintained until further notice from the Commission.
‘So for practices that were due to have an onsite assessment, those assessments were cancelled until further notice on the understanding that practices of course continue what they do, business as usual, to maintain their current level of work and practice to meet the Standards,’ Dr Acland told newsGP.
Under the usual three-year accreditation cycle, general practices have 12 months before the expiration of their certificate to register with an agency to commence the process of renewal.
But for the time being, Dr Acland says there is ‘no need for practices to actively engage with that process’.
Accreditation certificates will not be reissued by the Commission until the pandemic enters the recovery phase, at which time new certificates will be issued with their revised expiry date.
General practices and regional training organisations that require up-to-date documents to demonstrate their accreditation status so as to maintain registrars are exempt during this period.
‘If a practice’s accreditation was due to expire and they’re worried that they weren’t going to be able to maintain their accreditation and be able to keep having registrars on the teams, that is not an issue,’ Dr Acland explained.
‘Those practices are able to maintain the accreditation status and maintain their capacity to continue to have registrars.’
General practices in the process of having their ownership transferred due to relocating are also covered.
As onsite inspections have been postponed, practices that require an accreditation certificate with their new address for Services Australia and have had their PIP payments withheld, will be covered by an interim arrangement developed by the Commission and the Department of Health (DoH).
‘The Commission has come up with an attestation statement whereby those practices can complete it with the business nominee contact saying that they’re going to work to the Standards until that assessment is able to be made,’ Dr Acland said.
‘So it’s a special consideration that’s been put into practice.’
The attestation statement is a legal declaration noting compliance to the Standards. It needs to be completed by a business nominee contact with full legal responsibility and emailed to the Commission for processing. The accrediting agency will then be notified and Services Australia will be advised to release any relevant payments, including any back payments.
Once assessments are reintroduced, general practices must ensure an onsite visit is scheduled within three months.
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Coronavirus: Myths, open questions and overhyped treatments
GP Dr Magdalena Simonis sifts through the sea of information on the coronavirus and separates facts from fiction.
As the global coronavirus crisis deepens, misinformation, exaggerated breakthroughs and over-hyped ‘cures’ are circulating widely.
For GP and medical educator Dr Magdalena Simonis, it’s not an abstraction. Her patients bring in all kinds of theories and anxieties picked up on social media.
‘There are all sorts of peculiar things circulating, coming in from dribs and drabs from various patients,’ she told newsGP.
She’s not alone.
Meanwhile, Chair of the RACGP Expert Committee – Quality Care (REC–QC) Professor Mark Morgan told newsGP that it is hard to identify all of the ‘quack remedies and myths that are circulating through social media’.
Dr Simonis has gone through some of the most common myths, open questions, and overhyped treatments to sift the truth from falsehood – or to say that we simply don’t know enough yet one way or another.
Get the full story, and read more.
What do GPs need to consider when setting up telehealth?
Usability, security, privacy, cost and integration are all important factors, GP and former IT administrator Dr David Adam writes.
COVID-19 has required practices across Australia to transition to telehealth in an exceedingly short period of time.
Developments expected to take years have suddenly been thrust upon us as part of the Government’s response to the pandemic, leaving some practices scrambling to successfully establish brand new systems in a very short space of time.
As many have discovered, there are no easy answers. The Electronic Frontiers Foundation provides a sound explanation for some of the security aspects of communicating remotely, but this is only one piece of the puzzle.
Above all, practice staff and patients need to be able to use the technology you choose.
For example, tools like healthdirect Video Call require no installation or signup, but do need a relatively modern browser – and communicating that concept with the less technically-literate can be a challenge.
Conversely, many older people have been video-calling their grandkids for years and are familiar with platforms such as FaceTime or Skype, but these come with their own issues and may not be suitable for all consultations.
Security is of upmost importance, and in this day and age it is unusual for services to not offer some degree of encryption.
At a minimum, the communication between clients must use transport encryption, just as most websites do – especially commerce and banking.
Other services advertise ‘end-to-end encryption’, which means the service provider cannot interfere with the connection in any way. However, this is actually a difficult technical proposition, and sometimes just as hard to verify that it is in place.
End-to-end encryption is mostly useful to protect against government eavesdropping and major service provider compromise. Remember also that the phone system is not end-to-end encrypted.
Security is important because just like a standard consultation, privacy is paramount – for both patients and practitioners.
Many platforms require a mobile phone number to activate and connect, which can risk exposing your personal information. One tip is that a cheap prepaid mobile service can be purchased to activate the service, and then the practice’s Wi-Fi used for the actual calls themselves.
I would also advise against most ‘meeting’ applications, as these are generally designed to get multiple people into the same session, which is the opposite of what you want. This includes tools like WebEx, Microsoft Teams and GoToMeeting.
Free services such as Zoom (which I would also recommend against) can be tempting as cost is always a consideration, especially for small business.
The RACGP’s telehealth guide encourages caution with free services, as they may not meet security and privacy requirements. However, this sensible warning seems to have become gospel, which isn’t entirely warranted.
Although it’s true that low-cost options may make money by selling information (which may be quite private, such as call location and identification), many free services are simply run as a loss-leader. Companies may pursue this route to encourage uptake and purchase of add-ons (eg Skype), or because they have not quite figured out how to make money from the service yet (eg WhatsApp).
healthdirect Video Call costs money, but some Primary Health Networks (PHNs) are paying for it on behalf of practices. Having a paid agreement in place might also make it easier for you to gain the attention of the provider when it comes to getting help and support.
Whatever platform you choose, integration with clinical software is a must.
Some packages offer to integrate with your appointment book to ease the burden on receptionists and practitioners. Crucially, the effectiveness of these systems can vary and there are few options currently available for the Australian market, so research is required (a number of Australian eHealth experts are also working hard on this, so the landscape may change).
Of course, none of these systems will work without the appropriate technology to support them. Anecdotal reports suggest webcams and laptops are currently harder to come by than personal protective equipment.
If you are going to ask practitioners to use their own phones, laptops or desktop computers, you will need to make sure you preserve the privacy of their contact details and that their personal devices meet the same standards for security you expect from your practice equipment.
Likewise, practices must be prepared should there be some kind of failure with the technology.
There is currently massive demand for all online services. Microsoft, for example, has reported a seven-fold increase in the use of its video chat platform in Italy.
As such, doctors and practices should have contingencies in place should the chosen service experience technical issues. For example, you might have some accounts with a free service set up to use in case your chosen service is down, while the telephone can be another option if you need a fall back.
With all that being said, here are a couple of platforms I would personally recommend considering:
healthdirect Video Call – this is a platform paid for by the Australian Government and some PHNs. It requires no software installation or patients to sign up for an account, but does require them to have a new version of a modern web browser installed and working. You can contact your PHN to see if they have this option available.
Skype – this is a platform well-tested and anecdotally more popular with some of our senior patients. You can create a new account without disclosing your mobile number, and there are versions available for all devices.
WhatsApp – this is another popular platform and features a number of strong security features. It is quite easy to use but requires a smartphone and mobile number, and also risks exposing the practitioner’s personal number unless using a separate subscription for this service.
I personally recommend not using these platforms for health consultations:
Most ‘meeting’ applications like WebEx, Microsoft Teams and GoToMeeting. As previously mentioned, these are generally designed to get multiple people into the same session, which has privacy and security implications.
Zoom – this product and the company behind it have come under scrutiny, not just because of security and privacy issues, but also how they have handled them. While open disclosure and root cause analysis are familiar concepts to healthcare professionals, they are often poorly understood in technical organisations.
For those seeking more information, the RACGP’s telehealth guide covers some of the other steps practices need to take, such as verifying patient identity for all consultations.
These are important regardless of the technology you choose, and I would encourage everyone transitioning to telehealth to utilise all of the resources it contains.
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Pharmacy home delivery service now available
Following the Australian Government's announcement to allocate $25 million to fund home medicine services in the wake of COVID-19, Australia Post, in association with the Pharmacy Guild of Australia has announced the launch of its Pharmacy Home Delivery Service.
[A pharmacy] can offer free delivery on prescriptions to customers, taking advantage of the recently announced increased Australian Government rebate. The initiative incorporates Australia Post's contactless delivery in line with current COVID-19 guidelines.
This delivery option will support vulnerable Australians, including those:
isolating themselves at home on the advice of a medical practitioner
over the age of 70
with chronic health conditions
The initiative allows vulnerable members of the community to receive medication and other essential supplies (under 500grams) through Australia Post's Express Post network¹, once a month, and pharmacies can receive the full cost back through government rebate.
Other delivery options are also available, which can be viewed after completing the registration process. To send, you can drop your parcels directly into a street Yellow Posting Box or at a Post Office.
[The pharmacy's] customers will receive delivery notifications to help them track the progress of their delivery - and [the pharmacy will] be able to check the delivery status of [their] parcels through the MyPost Business dashboard.
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What does electronic prescribing mean for GPs in the fight against coronavirus?
GPs can now send prescriptions to pharmacists electronically as an interim solution during the pandemic.
‘This is a vital part of the puzzle to enable GPs to continue providing the same quality care to their patients via telehealth as they do face to face.’
RACGP President Dr Harry Nespolon has hailed the Federal Government’s response to strong lobbying by the college as a ‘breakthrough’ for GPs in the fight against coronavirus.
As part of the COVID-19 National Health Plan telehealth model, the new interim measure allows GPs to send prescriptions electronically to pharmacists without having to mail out a physical copy of the original paper prescription with a GP’s wet-ink signature.
Patients can then have their script filled and medication delivered to their door, helping to minimise the risk of virus transmission in accordance with social-distancing measures.
Dr Nathan Pinskier, GP and member of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), says the arrangement is a positive step forward with ‘huge benefits’ for practices during the crisis.
‘It’s certainly going to make it easier for practices, because they are being inundated with pharmacists asking them to post prescriptions to them,’ he told newsGP.
‘I know at my practices it’s causing substantial concern.
‘We’re getting calls every day from pharmacists saying, “I can’t dispense unless you send me the hardcopy paper”, and we’re saying, “We don’t have the resources to keep running out and buying stamps, and it’s just not safe to put staff in that position”.
‘So we’ve had a bit of a stalemate for the last few weeks and this is a great outcome in the short term.’
As outlined in guidelines issued by the Department of Health (DoH), GPs will be required to do as follows:
Create a paper prescription during a telehealth consultation. This will need to be signed as normal or using a valid digital signature
Create a clear copy of the entire prescription (a digital image such as a photo or PDF including the barcode where applicable)
Send via email, fax or text message directly to the patient’s pharmacy of choice
Schedule 8 and 4(D) medicines such as opioids and fentanyl are not part of the interim arrangement.
If the digital copy of the script is being sent via email, Dr Pinskier highlights the need for GPs to inform patients of the small, yet possible, privacy risk.
‘Clinical communication sent over ordinary email could be intercepted,’ he said. ‘So it’s really important that practices and doctors ask the patient if they are comfortable with it being sent by ordinary email.
‘It’s a safety measure in terms of minimising the risk of being exposed to COVID-19, but the patient should be aware of it.’
If the patient prefers to receive the legal paper prescription, the practice will need to mail it to them. When it comes to a digital copy of the prescription, however, the new guidelines stipulate that GPs must only send the script to the pharmacist.
While not legally required, the DoH encourages practices that are able to continue sending the original script to pharmacies to do so as soon as possible. All other practices must retain the paper prescription for a period of up to two years for audit and compliance purposes.
Vulnerable patients with existing prescriptions or repeats who are self-isolating will require someone to visit the pharmacy with the original prescription on their behalf. Alternatively, they will need to have a new prescription issued by their GP via telehealth.
It is important that GPs check they have the correct address for patients during the telehealth consultation, as once dispensed, medicines will only be delivered to the address printed on the prescription.
At this stage, the DoH has said the arrangement will cease on 30 September in accordance with the COVID-19 National Health Plan telehealth measure.
‘It’s not a long-term solution, but for the next few months it will certainly meet the requirements,’ Dr Pinskier said.
‘The long-term problem is, if COVID-19 persists for eight to 24 months, we’ll be storing a lot of paper in our practices and that’s probably not a good thing.
‘We may need to have another conversation with the Government down the track if that becomes an issue.’
The Federal Government has a new Electronic Prescribing (EPP) system in the works that generates a QR code and is sent to a patient’s device. The DoH has sped up the process in response to the current health crisis, and estimates it will be ready for use in practices by May.
But Dr Pinskier says this is an ambitious move during a pandemic and, given the history of software rollout in healthcare, is ‘likely to take longer’.
‘It’d be great if in three months every practice and every pharmacy has the capability to legal prescribing [in this way]. But it will still require an interim measure because if the patient’s not going into the pharmacy the QR token still needs to be somehow delivered to the pharmacy,’ he said.
‘So maybe we’ll still be going through a similar process using a newer technology.’
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National clinical guidelines launched for COVID-19
A large coalition of peak Australian health professional groups has come together to develop new “living guidelines” that will provide world-first, continually updated evidence-based guidance to clinicians caring for people with COVID-19.
This innovation has been developed under the auspices of the National COVID-19 Clinical Evidence Taskforce. The new Taskforce has been convened by the Australian Living Evidence Consortium which is based at Cochrane Australia in the School of Public Health and Preventive Medicine at Monash University. Teams of researchers, experts and clinicians have been working around the clock to deliver national guidelines for the clinical care of people with COVID-19 across primary, acute and critical care settings.
Chair of the Taskforce, Associate Professor Julian Elliott, says Australia’s world-leading efforts in generating ‘living’ clinical guidelines in areas like stroke and diabetes have now pivoted to focus wholly on helping clinicians manage COVID-19.
“There is urgent need to arm Australia’s healthcare professionals with evidence-based guidance about how best to care for people with COVID-19. These will be ‘living guidelines’, updated with new research in near real-time in order to give reliable, up-to-the minute recommendations to the clinicians during this unprecedented health crisis. These guidelines will help our frontline clinicians treat COVID-19 with confidence, knowing that their approach is backed by evidence and the very latest research from around the world,” said Professor Elliott.
Using ground-breaking evidence surveillance and automation technologies, the Taskforce will identify and summarise global COVID-19 research findings and feed this evidence to guideline panels every week, drawn from across Australia’s clinical and consumer communities. The results will then be delivered into the hands of clinicians at point of care. This will provide a trusted ‘single source’ of advice to help inform clinical decisions.
“This is about ensuring that Australian clinicians are supported at the front line with the right information. There is a lot of conflicting advice circulating and not all of it is based on good quality evidence. We can leverage our world-leading technologies and our partnership with the globally trusted Cochrane network to make sure Australian healthcare professionals have the very best information at their finger-tips,” said Professor Elliott.
The Australian Government has announced that it will provide funding to support the Taskforce, together with contributions from the Victorian Government, the Ian Potter Foundation and the Walter Cottman Endowment Fund managed by Equity Trustees.
The guidelines will form a key part of Australia’s response to COVID-19 and are available via www.covid19evidence.net.au.
The initial focus of the guidelines will be on:
Definitions of disease severity
Monitoring and markers of clinical deterioration
Antiviral medications and other disease modifying treatments
The Taskforce will now be working weekly with its members, partners and other stakeholders to monitor emerging evidence and expand the scope of the guideline recommendations in response to the most pressing needs of clinicians seeking to provide the best possible care during the pandemic.
Providing telephone and video consultations
Temporary MBS item numbers now allow telehealth (phone or video) consultations by GPs for all Australians, where it is safe and clinically appropriate to do so.
Summary information on these changes, including an overview of new items and descriptors, as well as changes to the bulk-billing requirements is now available via the RACGP website.
The RACGP has developed resources to support GPs in consulting remotely via phone and video during COVID-19. These resources are available via the RACGP website, with further to follow shortly.
If you have a query relating to the COVID-19 telehealth MBS items you can now email a new dedicated address, COVIDResponse@health.gov.au. For all other queries relating to all other items in the Schedule, continue to email askMBS@health.gov.au.
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Prescribing and dispensing medicines
The Department of Health has put in place a Special Arrangement that makes it easier for patients to access prescription medicines while self-isolating. The Special Arrangement commenced on 26 March 2020 to temporarily allow Image Based Supply of PBS Medicines, and also temporarily allow patients to receive PBS medicines without needing to sign for it.
This means that prescribers can provide a pharmacy with a digital image of their prescription via fax, email or text message. The pharmacist can dispense from the image of the prescription*, and can deliver or post the medicines to the patient. NB: *does not apply for a Schedule 8 or Schedule 4(D) medicine
If your patient prefers to receive the legal paper prescription you will need to mail it to them.
If able, you should send the pharmacy the paper prescription as soon as possible. If you are unable to send on the paper prescription, you will be required to retain the paper prescription for a period of 2 years for audit and compliance purposes.
The COVID-19 Home Medicines Service enables vulnerable patients to have their PBS medicines delivered to their home. The Home Medicines Service complements the expanded use of telehealth under Medicare and the fast-tracking of electronic prescribing.
GPs can now request an authority using Online PBS Authorities in HPOS.
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