August 13, 2021
A recent article in the NZ Listener about GP burnout made concerning, but not entirely surprising reading. Primary care, it seems, is not immune to the leaky bucket syndrome effecting many other parts of the health system.
Leaky bucket syndrome occurs when the number of health professionals able to deliver care diminishes at a rate faster than the population they need to care for.
According to the article, GPs are retiring or choosing to work less hours and there aren’t enough new GPs to plug the holes. More holes make it harder for consumers to access primary care and this has a flow on impact for secondary care.
This “future crisis” is looming particularly large because the number of people that need care is actually increasing, i.e., the tap is slowly being turned up due to a growing and aging population.
In 2001 we had 85 GPs for every 100,000 kiwis, now we have just 73. Australia has 110.
To manage overwhelming demand, many New Zealand GP practices have begun triaging requests for same day appointments via telephone callback. This has reduced the number of unnecessary in-person appointments and freed up time for urgent clinic visits.
In a speech earlier this year, The Hon. Andrew Little (Minister of Health) called out the need to reduce the number of unnecessary GP visits. Unnecessary visits being those that could be conducted remotely, safely deferred, or handled by another care provider such as a nurse or pharmacist.
This is quite a lot harder than it sounds. Many GPs are completely overloaded with bookings. Some studies have found that the top 10% of attendees account for 50% of all contacts. These people often have complex and chronic health problems, many of them are older and also suffer from loneliness.
Determining which bookings are unnecessary takes time and resources that GPs don’t have. However, it could be made a great deal easier if GP practices could refer so called “frequent flyers” to a funded telehealth service. A telehealth service could give GPs regular updates about their patient’s health via a succinct report with health data recorded on easy to use, purpose built, age-friendly devices.
Spritely is taking steps to help with this. We are a member of the NZ Virtual Health Industry Group (part of NZHIT) recommending that a new standard be developed to communicate health information from personal devices to GPs for the benefit of their more vulnerable patients, many of whom are over 75 years old.
This study from the US, and many others like it from around the world, found that people who recorded their blood pressure with an app remotely connected with a clinician, had significantly improved outcomes.
There is no shortage of evidence that telehealth can help improve outcomes for people that suffer from chronic conditions. However, there are some clear obstacles to its adoption such as the funding issues identified in the article.
No-one is paying GPs to sit and review a stream of personal health data recorded by the patients themselves. And as the NZ Listener article pointed out, GP time in this country is already at an absolute premium.
A targeted telehealth service could improve capacity in specific areas of the health system.
If vulnerable kiwis, with chronic illness (such as hypertension, COPD, or diabetes) are remotely supported by a dedicated service provider with a high level of consumer trust, then they won’t need to attend GP clinics as often and hospital visits could be reduced.
Telemonitoring doesn’t replace in-person care, it supplements it. A telenurse can handle some routine consultations, creating space for more complex or urgent appointments when needed.
Spritely’s fully managed device kit enables remote assessment and care planning, regular video consultations, appointment booking, wireless vitals recording, automated monitoring, health reporting, and medication management.
Spritely already records thousands of health vitals every month. We work with St John to proactively manage the care of older New Zealanders and liaise with their GP or family members if there is cause for concern.
This is “telemonitoring-as-a-service”, and it has the power to relieve huge pressure on primary care (and the wider health system) by creating a GP buffer or “moat”, which reduces clinic visits from people who suffer chronic illness or are socially isolated. Evidence suggests that it can also improve health outcomes for a lot of people.
The question is, will telehealth-as-as-service eventually be funded in NZ as it is in other countries?