Medicare-reimbursed psychiatric consultations before and after telehealth expansion in Australia: a time series study

Abstract

Objective Telepsychiatry consultations grew rapidly with increased total consultations and reduced face-to-face consultations following the pandemic-triggered expansion of Medicare Benefits Schedule (MBS) telehealth items. It was unclear how much telehealth expansion independently impacted overall and face-to-face consultation trends after accounting for lockdown severity. Methods We extracted monthly MBS Item Reports for psychiatric consultations (January 2012-December 2023). The monthly average Stringency Index (SI) for Australia represented lockdown severity from January 2020 to December 2022. A dichotomous variable denoted telehealth expansion (March 2020 onward). We constructed consecutive multiple linear regression models for combined consultations and face-to-face consultations to include seasonality, trend, SI, and telehealth expansion. We compared model performance using information criteria. Results Median monthly total consultations increased from 148,413 (Interquartile range, IQR: 138,219-153,709) pre-expansion (January 2012-February 2020) to 173,016 (IQR: 158,292-182,463) post-expansion (March 2020-December 2023). Contrarily, median monthly face-to-face consultations decreased from 143,726 (IQR: 135,812-150,153) to 99,272 (IQR: 87,513-107,778). Seasonality and trend were present in both time series. The time series regression model with expansion but excluding SI best explained all consultations, while both telehealth expansion and SI were significant in the best-fit model for face-to-face consultations. Conclusion MBS telehealth expansion was associated with total and face-to-face consultations independent of lockdown severity changes. Policy changes allowing wider access to new telehealth services have possibly led to increased uptake of psychiatric care and addressed previously unmet needs.