Telehealth and telephone triage being planned for pandemic clinics
CANBERRA: Telehealth and telephone triage services will be deployed in the event of a large outbreak of coronavirus disease 2019 (COVID-19) amid plans to direct the majority of people with mild symptoms to respiratory clinics and away from hospital EDs, Australia’s chief medical officer says.
Planning is also underway to make testing for the virus available through private pathology practices, with public health laboratories having tested well over 10,000 Australians so far, the vast majority of them negative.
RACGP president Harry Nespolon said that the college had asked the government to provide an MBS item number to bill for telehealth consults during the outbreak. “Taking phone calls to triage people will be inevitable and we need to be compensated to do that, to tell people whether they should come into the clinic or go to a hospital,” Dr Nespolon said.
CMO Brendan Murphy confirmed at Senate estimates today that the department was looking at a specific MBS item number for GPs providing services to patients with coronavirus, not just those at specific fever clinics.
“Telehealth at the moment for GPs is generally available only in remote areas, and we are looking at a range of funding options to make sure that GPs who are providing services to coronavirus people are properly reimbursed,” Professor Murphy said.
“We may contract specific clinics to set up in a direct funding way, but we are certainly looking at telehealth items not only for coronavirus consultations but potentially for people with chronic disease so they could have a consultation with their GP without having to go to the practice if they are worried about getting out.”
The department is holding a GP roundtable on Friday with the sector’s peak bodies.
At present the focus of future pandemic planning is on the aged care sector, he said. An aged care worker from Sydney was today named as the third person to have acquired the virus without having travelled overseas.
The woman has been quarantined in hospital and staff and other residents are being tested, NSW Health says. 40 healthcare workers from Ryde Hospital, including 23 nurses and 13 doctors, have also been quarantined after coming into contact with a doctor diagnosed with COVID-19 on Monday. New Zealand has also today announced its second case of COVID-19.
“The aged care sector is one where we are doing a lot of planning with the sector,” Professor Murphy said.
“We’ve got a large planning day later this week and we are very focused on … surge workforce [capacity and] making sure they are well prepared in terms of the established protocols that they all have to deal with for flu outbreaks and infection control and cohorting and all of those sort of elements.”
Professor Murphy said public health authorities are also keen to work in the primary care sector in the case of very large numbers of infections. At present the focus is on containment and limitation to slow any spread, but in the case of a large outbreak in the community, authorities are keen to ensure people do not flood hospitals.
“We want them being seen in ambulatory clinics and see them being looked after at home,” Professor Murphy said.
He said with over 80 per cent of people who have caught the disease so far only showing mild symptoms – and children showing few symptoms at all – the plan is to manage most people in the community.
“The evidence suggests that it is better to cohort them as well, to set up what we call respiratory clinics or special clinics for ambulatory people, including access to telehealth services and telephone triage,” he said.
“We are working with the states and territories and in some cases they want to be involved in setting them up. In other cases the PHNs and the GPs will set up dedicated clinics so that you don’t mix people with the ordinary population and we are planning a network of these ready to be stood up as required across the country.”
Asked by Greens Senator Richard Di Natale if in the case of community transmission, the advice would be not to see a person’s regular GP, Professor Murphy said the advice would be to ring a number and they would then be directed to a specialist respiratory clinic.
“In a significant outbreak, that is the plan,” he said. “We are trying to reassure people that removing all of the lavatory paper from the shelves of supermarkets probably isn’t a proportionate or sensible thing to do at this time.”
For vulnerable people and those showing severe symptoms, the Department of Health is working with the states and territories to determine critical care capacity, he said. Queensland Health has announced it is bringing forward elective surgeries.
“We do know there is a small percentage of people who get serious lung involvement and they will need ventilator support and other intensive care,” Professor Murphy said. “We are working with the intensive care community working out what potential surge capacity is there. We are obviously very worried about Aboriginal and Torres Strait Islander Australians, who would be a vulnerable group, particularly in remote communities.”
In terms of the capacity to test a large number of people for a new disease, Professor Murphy said that was a big topic of discussion.
“At the moment the tests are being done in our public health laboratories,” he said. “We had to establish the test, it’s a new test, new primers, and they are now performing extremely well at every public health laboratory.
“There are now some commercial tests available and the private laboratories are very keen to get involved and to provide testing capacity and we are looking at how we do that. We will definitely need to expand the testing capacity.
“The public health labs have already tested well over 10,000 Australians with the great majority obviously negative. In a large outbreak you might need thousands of tests every day and we will need to expand that capacity.”
