Temporal Changes in Chronic Disease Management in Primary Care in Relation to Telehealth Policy Changes: Australian Whole-of-population Interrupted Time-Series Analysis

Background Universal telehealth aims to support access to timely coordinated chronic disease care. Large-scale evidence on the extent to which this occurs to guide telehealth policy is limited. Objective To examine temporal changes in uptake and timeliness of general practitioner chronic disease management (GP-CDM) services in Australia following universal telehealth introduction (March 2020) and removal of subsidized telephone (but not video) GP-CDM services (July 2021). Methods Whole-of-population cohort study of linked national claims and death data, 2018-2022. Interrupted time-series analyses quantified temporal changes in GP-CDM service uptake and timeliness following telehealth policy changes. Results From 2018 to 2022, each month an average of 568 858 GP-CDM services were delivered, with 25-43 users and 44-76 services per 1000 population aged 45-<85 per month. After universal telehealth introduction, GP-CDM uptake remained stable, with similar trends pre- and early-pandemic. Monthly uptake decreased substantially following the removal of telephone GP-CDM services [decrease of 4.0 users (95%CI -6.3, -1.7) and 6.9 services (-10.5, -3.3) per 1000 population]. In the first month of telehealth, 38.7% of people using GP-CDM services used telehealth (37% telephone, 1.7% video), declining to 2.2-5.4%/month after removal of telephone GP-CDM services. Small improvements in GP-CDM timeliness stalled once telephone services were no longer available. Patterns were similar across population subgroups. Conclusions Telehealth policies in Australia sustained access to chronic disease care during the pandemic. Limiting access to these services to video alone was associated with a greater than expected decline in use had the pandemic and introduction of telehealth not occurred.