Uptake of video telehealth in general practice: an Australian whole-of-population analysis

Abstract

Background: Video use remains low in primary care telehealth consultations. Little is known about patterns of use or policy levers to promote video. Aim: To investigate use of video telehealth in Australian general practice under permanent telehealth arrangements post-COVID-19 lockdowns, and during a policy change removing reimbursement for long telephone consultations. Design & setting: Whole-of-population analysis of 2022 national healthcare claims linked to 2021 census data. Method: We quantified the following: proportions of telehealth consultations by video, and of patients and GPs who used video for telehealth consultations; associations between video use and patient characteristics using Poisson regression; and video use in relation to policy changes using interrupted time-series analysis. Results: Of 38 million GP telehealth consultations in 2022, 5.1% were by video; 8.6% of patients and 62% of GPs who used telehealth had used video. Patients most likely to use video lived remotely, were frequent GP users, or had multiple health conditions, mental health conditions or dementia. Socioeconomic disadvantage was modestly associated with lower use of video. Over 2022, use of video for telehealth decreased for consultations (from 6.5% of consultations in January to 4.1% in December), patients (from 6.7% to 4.4%), and GPs (from 40.0% to 26.0%). Time-series analyses showed downward trends before removal of reimbursement for long telephone consultations, small step increases immediately following, and shallower negative trends thereafter. Conclusion: Use of video telehealth consultations in general practice in Australia is low and declining, more so for disadvantaged groups. Differential financial reimbursement of video and telephone consultations has not substantively increased video use in clinical practice.