A tool not a panacea: telehealth is overhyped as a solution to New Zealand’s rural health crisis.

Telehealth has been proposed as a solution to New Zealand’s ongoing health crisis, which is particularly prevalent in rural areas.

But moving health services online can have many unintended consequences for the health of patients and doctors.

Since the epidemic, there has been a growing emphasis on mobile services – the appointment of doctors through online platforms or by phone. This shift in focus is reflected in government policy announcements that emphasize telephone options, increased government funding and rapid expansion of providers.

Telehealth is seen by many as a way to expand access to care, reduce wait times and reduce services. But as my research shows, there are also problems with managing care online. These should not be ignored.

Advantages and disadvantages of telehealth

About 900,000 New Zealanders live in rural areas, according to the latest report from the Hauora Taiwhenua Rural Health Network. Their health effects can make for painful reading.

The report found that non-Maori men aged 30 to 44 were 1.8 times more likely to die from preventable causes than their urban peers. And Māori under 30 living in rural areas were twice as likely to die from a preventable disease than their urban counterparts.

As a rural general practitioner based in the remote Northland, I see the gap in access to health care first hand. For example, there hasn’t been a consistent doctor after hours for two years.

Telehealth has provided support for our patients and relief for overworked doctors.

On the plus side, I’m no longer woken up four times a night for phone calls when I have to work the next day. And for many patients, talking to a doctor over the phone for a simple matter is much easier than walking 30-40 minutes and waiting at the clinic.

Research has also found telehealth can be a more effective and culturally safe alternative to face-to-face consultations for Māori whānau.

However, my research has found that telehealth is hindering the continuity of care.

Continuity of care, in which the patient has a long-term relationship with the same doctor, has been shown to reduce mortality. The reduction in mortality due to continuity of care is 8% after two to three years and 25% after 15 years.

Putting pressure on other places

There are many other unintended consequences of adopting telehealth.

Conducting care online or over the phone can put pressure on other parts of the health care system. For example, it can increase the burden placed on rural nurses who have to manage very difficult conditions without the support of a local doctor.

The recent heart attack case at Dargaville Hospital where there was no doctor on site must have been a huge challenge for the nurses involved and very stressful for the whānau.

Research has also shown how telehealth can open the door to unsafe medical practices, such as inappropriate escalation or inappropriate ordering of medical tests and investigations.

In addition, telehealth doctors will not be able to deal with many health problems. These end up being returned to face-to-face physicians for strict management or to emergency rooms, thereby increasing the burden on these areas of care.

The meaning is lost

Telehealth doctors are often not based in the same location as the patient. This means that local conditions and knowledge can be lost.

I have seen patients inappropriately transferred to a rural hospital when they should have been sent to a larger urban hospital for higher quality treatment.

There is also a more surprising issue that may arise. When we try to solve the labor problem we actually make it worse.

Television providers are recruiting doctors who are already limited in New Zealand. This reduces the overall availability of physicians able to provide face-to-face care. It’s easy to see why this is a good choice for some. Teleheath conditions allow doctors to work from home with hours that suit their lifestyle.

A momentary thought

In general, solutions to deal with rural life do not seem to be driven by rural workers or rural residents. Rural residents want access to the same health care that everyone enjoys.

From 2023, Health NZ has introduced measures to address the rural health crisis. These include accommodation allowances of NZ$9,100 for primary care practitioners who live within 30 kilometers of their rural GP as well as funding for locum doctors, nurses and rural hospitalists to provide with security in rural general services and rural hospitals.

But health inequalities in rural areas have high mortality rates, particularly among Māori, and the funding needed to close this gap is elusive.

One of the most important factors that reduce mortality, continuing care with a regular doctor, does not appear to be a part of decision-making and strategic work.

Instead, progress in care is being sidelined by the continued disruption of the health care sector and the substitution of medical services for cheaper and easier options – such as telehealth. The government is not focusing on the investment required for doctors to enter rural areas.

Importantly, solutions to the problem of rural workers must come from rural residents and rural doctors who have the experience to know what will work.