Staying in touch while keeping your distance

Among other things, I am a husband, father, son-in-law, friend, colleague and healthcare researcher. These roles all require connections with others for me to function effectively in my private and working life. They usually work well, enabling me to enjoy my family, and social and professional worlds—even during the COVID-19 pandemic. Zoom and Skype, for example, have been very helpful and a lifeline for otherwise feeling cut off or isolated.

In 2020, we have all faced the enormous challenge of staying in touch with those who are important in our lives,yet keeping our distance when necessary. Staying in touch while maintaining distance—that’s what I’d like to discuss here. And it applies not just to individuals, but entire health systems.

Prior to 2020, who could have imagined not leaving home for a session with a GP or specialist? Now more than 40% of consultations can be done via phone or video. As a researcher, with colleagues, I advocated telehealth for many years, so to see it happen almost overnight was truly amazing.

Telehealth is just one example of an opportunity that has brought immediate and lasting improvement, in particular breaking down barriers of access for people who are isolated by circumstance or geography. Millions of us, staying in touch while keeping our distance, indeed.

We can deliver health services better

While there may be a yearning to return to how life used to be, pre-pandemically, let’s avoid the rose-coloured glasses—that tendency to think that all was well before. Prior to COVID-19, our healthcare system, while one of the best in the world, was already under pressure. One in ten patients suffered harm in hospital or ambulatory care; we wasted 30% of resources on care that provided no real value; and 60% of care was best practice, leaving ample room for improvement.

… a famous Sydney teaching hospital has a virtual ward…

While telehealth is the most ubiquitous of the innovations brought forward by the pandemic, other forms of virtual care have also been implemented. Armidale Hospital in the beautiful New England region of NSW supported COVID-19 positive patients to remain in their own homes by delivering clinical advice online. Royal Prince Alfred, a famous Sydney teaching hospital, has a virtual ward, established at the inception of the pandemic, which is flourishing. We have also seen the success of mobile testing clinics for COVID-19 that could provide a template for future pop-up vaccination clinics. Each of these initiatives not only relieves pressure on our hospitals, but also provides care closer to where people need it most, in the community.

But then there’s the worry of people not staying in touch. While some people have experienced improved access to healthcare, others have alarmingly avoided it, and distanced themselves too much from the very system designed to serve them. There has been a dramatic drop in visits to GPs and emergency departments, as well as significantly fewer routine cancer screenings and pathology tests raising fears of hidden health dangers. People remaining too far away from the care they need can lead to very poor health outcomes.

One way to combat this is through the numbers. A new project underway in parts of Victoria and NSW is capturing data from general medical practices to spot trends in pathology test ordering, enabling health professionals to react to changes in real time. A drop in the number of people having a cholesterol check for instance could lead to timely communication with at risk groups. Likewise, GPs, practice managers and health planners could be quickly alerted to falling trends in COVID-19 testing rates, telling them where to target resources.

… the opportunity to reassess what is known as low-value care.

While the pause in non-essential surgery has caused distress and inconvenience to many, with more than 400,000 operations delayed due to COVID-19, it has also provided the opportunity to reassess what is known as low-value care. These are procedures that evidence has shown, provide little or no benefit to the patient. In NSW alone, unnecessary surgery is estimated to cost more than AU$49.9 million annually in the public sector. In the private sector across Australia, low-value care accounts for up to AU$211 million in hospital benefits and nearly AU$62 million in medical benefits annually.

While lower back pain for instance can be treated with spinal surgery, other non-surgical interventions have proven effective for many people, and less costly to the individual and the health system. Simple analgesics and physiotherapy or light exercise, or a combination, for example, can help. Likewise, there are non-surgical alternatives to knee arthroscopy, total hip and knee replacements, hysterectomy, colonoscopy, endoscopy, carotid endarterectomy, abdominal aortic aneurysm repair, and hernia repair. More information is available at Choosing Wisely.

 We can be better prepared

Many times before COVID-19, there were events that stretched the system, sometimes to breaking point. The 2019/2020 bushfires shook communities nationwide and tested the capacity of the system in a crisis. This, along with COVID-19, will not be the last time our health system is challenged and there is much to learn about building a system that can absorb unexpected shocks and continue to function. But in the depths of such problems, communities can rally to solve problems together: staying in touch and remaining connected.

While the COVID-19 pandemic is the current focus of concern, Australia also faces the challenge of a population that is rapidly ageing. We are not only living longer, half of all Australians have more than one chronic condition such as heart disease and diabetes. Added to this, the long-term health implications for those who survive being infected with COVID-19 are still unclear, however chronic fatigue, respiratory issues, inflammation of the heart and sudden onset diabetes are emerging in some people.

… I welcome the health system’s sharpening of focus as a consequence of the pandemic.

If not properly managed, recurrent hospitalisations can become the norm. Far better is to build a health system that supports people to be healthier, avoiding ill-health as much as possible through diet, exercise and other preventative strategies. For COVID-19 these include of course getting tested if symptoms appear, but not getting the infection in the first place—through social distancing, washing hands regularly and thoroughly, and wearing a mask—is much better.

As a family member, health consumer and a systems researcher, I welcome the health system’s sharpening of focus as a consequence of the pandemic. Learning how to deliver care to people wherever they are in Australia, when they need it and in a form the health system can sustain long term, even in the face of a pandemic, it turns out, is the only way to go. Keeping everyone in touch, but at a distance where appropriate.