Melbourne Institute of Applied Economic and Social Research - Research Publications

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http://hdl.handle.net/11343/414

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Association between telehealth use and general practitioner characteristics during COVID-19: findings from a nationally representative survey of Australian doctors

Scott, A ; Bai, T ; Zhang, Y (BMJ PUBLISHING GROUP, 2021)

OBJECTIVE: To investigate factors associated with the use of telehealth by general practitioners (GPs) during COVID-19. DESIGN: A nationally representative longitudinal survey study of Australian doctors analysed using regression analysis. SETTING: General practice in Australia during the COVID-19 pandemic. PARTICIPANTS: 448 GPs who completed both the 11th wave (2018-2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) Survey and the MABEL COVID-19 Special Online Survey (May 2020). OUTCOME MEASURES: Proportion of all consultations delivered via telephone (audio) or video (audiovisual); proportion of telehealth consultations delivered via video. RESULTS: 46.1% of GP services were provided using telehealth in early May 2020, with 6.4% of all telehealth consultations delivered via video. Higher proportions of telehealth consultations were observed in GPs in larger practices compared with solo GPs: between +0.21 (95% CI +0.07 to +0.35) and +0.28 (95% CI +0.13 to +0.44). Greater proportions of telehealth consultations were delivered through video for GPs with appropriate infrastructure and for GPs with more complex patients: +0.10 (95% CI +0.04 to +0.16) and +0.04 (95% CI +0.00 to +0.08), respectively. Lower proportions of telehealth consultations were delivered via video for GPs over 55 years old compared with GPs under 35 years old: between -0.08 (95% CI -0.02 to -0.15) and -0.15 (95% CI -0.07 to -0.22), and for GPs in postcodes with a higher proportion of patients over 65 years old: -0.005 (95% CI -0.001 to -0.008) for each percentage point increase in the population over 65 years old. CONCLUSIONS: GP characteristics are strongly associated with patterns of telehealth use in clinical work. Infrastructure support and relative pricing of different consultation modes may be useful policy instruments to encourage GPs to deliver care by the most appropriate method.
Who is avoiding necessary health care during the COVID-19 pandemic?

Zhang, Y ; Liu, J ; Scott, A (Melbourne Institute of Applied Economic and Social Research, 2020-06-01)

Australians experiencing high levels of financial stress and mental distress are not seeking needed health care. This study looks into what policies could help encourage greater use of necessary health care to improve wellbeing and avoid more expensive care later on.
Using health care during the pandemic: should I stay or should I go?

Zhang, Y ; Liu, J ; Scott, A (Melbourne Institute of Applied Economic and Social Research, 2020-09-01)

The COVID-19 pandemic has caused significant financial and mental distress for many Australians, which according to results from Taking the Pulse of the Nation in early June, has caused some to avoid visiting a health care professional when needed. As the pandemic continues, are people still delaying seeing a doctor or has their been a resurgence in visits after people delayed their care earlier in the year? In this Research Insight, Professor Yuting Zhang, Dr. Judith Liu, and Professor Anthony Scott examine Australians' use of health care and telehealth, focusing on what changes have occured since early June. To understand how COVID-19 has impacted decision-making around seeing a health care professional, data from Taking the Pulse of the Nation have been used to see who has avoided seeing a doctor, who has sought health care, and who has used telehealth.
Who is ditching private health insurance during the pandemic?

Zhang, Y ; Liu, J ; Scott, A (Melbourne Institute of Applied Economic and Social Research, 2020-11-01)

Following the recent increase in private health insurance (PHI) premiums in October, as well as people's growing financial and mental stresses due to the COVID-19 pandemic, many Australians may be wondering whether they should drop or downgrade their PHI. In this Research Insight, authors Professor Yuting Zhang, Dr Judith Liu, and Professor Anthony Scott examine how Australians have changed their PHI memberships during the pandemic. Using data from the Melbourne Institute's Taking the Pulse of the Nation survey, they look specifically at who has dropped, downgraded or upgraded their PHI since March 2020.
Factors affecting general practitioners' decisions to adopt new prescription drugs - Cohort analyses using Australian longitudinal physician survey data

Zhang, Y ; Méndez, SJ ; Scott, A (BioMed Central, 2019-02-07)

Background: We investigate factors affecting Australian general practitioners' decisions to adopt novel oral anticoagulants (NOACs) for the prevention of stroke/systemic embolism among patients with atrial fibrillation. Australia has a national homogeneous review and coverage system, which enables us to distinguish physician level factors while maintaining system level factors and patient coverage information constant. Methods: We conduct a cohort analyses by using longitudinal physician survey data from the Medicine in Australia: Balancing Employment and Life panel survey of Australian physicians (MABEL). MABEL data contain rich physician-level information such as age, gender, education, risk preferences, personality, physicians' communications with other medical professionals, and other practice characteristics. Importantly, the survey data were linked, with physician's consent, to actual utilization data from the Australian Pharmaceutical Benefits Scheme and the Medicare Benefits Schedule between January 1, 2012 and December 31, 2015. We measure speed (days until first time prescribing) of adopting NOACs. We estimate a Cox proportional hazard model to estimate factors affecting the adoption speed. Results: Several factors predict earlier adoption of NOACs: being male, more likely to take clinical risk, higher prescribing volume, being a principal or partner in the practice instead of an employee, spending less time in a typical consultation, and practicing in more affluent areas or areas with a higher proportion of older patients. GPs in Queensland are more likely to adopt NOACs and more likely to be extensive early adopters compared to other GPs. Other characteristics including physician personality, family circumstances, their involvement with public hospitals and teaching activities, and the distance between physician practice location to other clinics in the area are not statistically associated with earlier adoption. Conclusions: Our paper is one of the first to study the relationship between GPs' risk preferences, personality and their decisions to adopt new prescription drugs. Because NOACs are commonly prescribed and considered more cost-effective than their older counterpart, understanding factors affecting physicians' decisions to adopt NOACs has direct policy implications. Our results also highlight that even with universal coverage for prescription drugs, access to new drugs is different among patients, partially because who their doctors are and where they practice.