A collaboration between ProCare and Southern Cross Health Insurance is helping remove barriers to healthcare for those who find it hard to access.
For some, attending a GP appointment in person can be a major logistical burden. It can mean time away from work, time navigating traffic or travelling long distances if you live rurally, time wrestling children into their car seats or time organising someone else to look after them. All of this can be stressful and difficult to manage. These experiences mean some people find it not worth the effort of trying to seek the treatment they need from their GP.
The Southern Cross Healthy Futures report 2020 supports this view, showing that alongside monetary cost, there were many other reasons people didn’t access healthcare when they felt unwell. GP availability, time and distance were some of the most cited reasons. But with the increasing digitisation of healthcare, many of those issues can be addressed.
A partnership between primary health organisation (PHO) ProCare and the not-for-profit Southern Cross Health Insurance has resulted in the development of an online GP service CareHQ, which makes it easier for people to get quick, efficient, quality healthcare that cuts out the added stresses in-person appointments can sometimes bring.
“With four clicks, a patient can log in to their CareHQ app and see a doctor at a time which fits around their schedule,” says Dr Reza Jarral, GP and the clinical director for CareHQ.
Jarral’s witnessed first-hand the barriers – systemic and physical – that can prevent people from seeing their GP. He says he’s excited to be working to address some of the healthcare inequities people are facing in New Zealand. But it took some drastic pressure on the health system to get the momentum needed to make it happen, as Covid-19 pushed digital healthcare to the forefront in 2020.
“GPs have known for some time that Kiwis needed a safe way to access care remotely, but Covid-19 sped up that process as literally overnight we were required to deliver care to 70% of our patients virtually,” Jarral says.
ProCare and Southern Cross had already identified the need for a service like CareHQ before the pandemic. The development of CareHQ was already underway before the outbreak of Covid-19 which meant it could be launched toward the end of 2020.
There are limitations to what the virtual appointments can be used for, but Jarral says it’s surprising just how much can be managed online.
“We see people for coughs and colds, cuts and bruises, minor injuries, mental health problems and increasingly we’re exploring how we can deliver care for more chronic conditions, in very close partnership with patients’ registered primary care providers.”
After-hours care comes with a heftier price tag than regular GP visits and this is another essential role for CareHQ. A trip to an urgent care clinic at 10pm can cost patients over $100, and wait times are often hours-long. Surprisingly, Jarral says up to one in every five ED patients could be treated with a virtual consultation.
The doctors he works with on CareHQ have even helped diagnose sepsis, diabetes and serious digestive conditions, acting as a virtual triage service – forwarding patients through to necessary specialists or an in person visit with their registered usual family doctor.
The online healthcare platform of CareHQ provides opportunities to impact communities that are currently under-served by the health system. Jarral says most of the early uptake patients are women and he hopes with time this will diversify to include large numbers of youth, rural communities and other people for whom in-person visits are challenging.
“We’re predominantly helping people who are busy, often juggling the school run, work and caring for their whānau, also younger people who are digital natives having grown up with apps and smart devices.”
He’s been surprised at how open people have been with their health issues over online appointments. He thinks for young people – generations that have grown up communicating through tech – it may be easier to talk about these things via a screen, rather than in person.
“What’s amazing is their comfort level in discussing mental health challenges, tackling vulnerability head-on through the digital medium. Sometimes younger patients might be reluctant to engage with traditional brick and mortar services, for a variety of reasons – including anxiety, fear and stigma.”
Online appointments must deliver the same privacy standards of in-person care, and this has been one of the biggest focus areas in the design of CareHQ. The app was purpose-built to ensure multiple layers of security for keeping patients and their information safe. There’s a two-point verification system for doctors, and appointments are only conducted from private, sound-controlled rooms. Doctors are trained to ensure their patients are in safe places too.
“The first questions you are asked when you begin a CareHQ appointment is: ‘Are you in a safe place? Are you feeling comfortable to speak right now?’ It’s really important that we ask that and see that patients are in a safe environment and they also feel safe,” Jarral says.
As the general workforce has adapted to working from home through the pandemic, the medical profession has continued to put themselves on the front line, providing in-person care for those who need it.
“It’s really changed the way that a lot of our GPs work,” says Jarral. “We’ve allowed them to change their working patterns around their home times and not the other way around.”
One of the most important things in the development of CareHQ was building a model that would be beneficial for GPs as well as patients. There was concern that virtual healthcare would take patients – and funding – away from GPs and the primary healthcare sector.
Stephen Child, the chief medical officer for Southern Cross Health Insurance, says the relationship between a person and their regular family doctor is crucial, and it’s for this reason CareHQ doesn’t enrol patients.
CareHQ is designed to support a patient’s connection to their enrolled practice and offers the option of having consultation notes sent to their regular GP. If someone has an online consultation with CareHQ and they aren’t enrolled with a general practice, it’s explained to them why it’s important to have a regular GP and they’re guided on the best way to find a practice to enrol with.
“It’s extremely accessible. For seven days a week, 12 hours a day you can contact a doctor – you don’t have to be a Southern Cross Health Insurance member, anyone in New Zealand can access the service,” he says.
“The difference between CareHQ and other virtual health offerings is that we’re working with general practice, respecting the importance of maintaining those special relationships and continuity between the doctor and their patient.”
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