Providing healthcare to rural and remote populations is one of Australia's most enduring challenges but has also created some of our greatest innovations.
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One example is the story of a postmaster in Halls Creek in remote WA in 1917 forced to rely on morse code instructions from a surgeon in Perth 2500km away to perform surgery on an injured stockman. This helped give Rev John Flynn the inspiration to establish what has now become the Royal Flying Doctor Service.
How best to give Australians universal health care in such conditions still occupies policymakers.
In April, a Senate committee report made nine recommendations. One word that's relatively absent in these discussions but should be considered by new Health Minister Mark Butler is technology.
The COVID-19 pandemic proved how central technology is to providing quality, timely and universal care. Telehealth ensured patients maintained care of chronic conditions, while diagnostic technology (PCR and rapid antigen tests), combined with our world-class pathology systems, allowed us to manage the virus for months without vaccines or treatments. Now is not the time to be putting up barriers to accessing this technology. The RAT subsidy for concession card holders should be extended beyond July.
Those in rural settings will feel its absence the most. Speed and convenience are virtues of technology that the public clearly appreciates.
We should do more to embrace such approaches. Rapid testing could be utilised for HIV, influenza and many other infectious diseases.
Rural Australians often experience worse health outcomes than people in cities.
Delays in diagnosis make effective treatment harder. Expanding access to rapid forms of testing in remote and rural primary care settings would allow doctors to diagnose and take immediate clinical action.
This would be transformative for patients, some of whom travel hundreds of kilometres to receive care.
Taking time off work during a cost-of-living crisis won't be an option for many.
Yet their healthcare needs are as important as ever. Funding pathways for rapid testing are evolving, but alongside immediate-term pathways, we should consider alternative mechanisms.
In the 2021 budget the federal government announced a $2.1 million investment for point-of-care glycated haemoglobin (HbA1c) tests for Australians with diabetes.
Studies show reductions in emergency room attendance and lower overall cost to the health system when testing is performed at the same time as a patient's health practitioner visit.
Technology solutions don't stop at diagnostics. Thanks to wireless technologies such as Bluetooth, medical devices now pair with mobile phone apps to provide real-time data to help manage chronic conditions remotely.
With a tap on the phone a patient in Broome can share heart rhythm data with a cardiologist in Brisbane, glucose variations through the day with an endocrinologist in Melbourne or connect with a neurologist in Sydney to manage Deep Brain Stimulation therapy for conditions such as Parkinson's disease.
The power of this technology was recognised during the election campaign. A bipartisan promise from the two major parties means all people with type 1 diabetes now have subsidised access to Continuous Glucose Monitoring (CGM).
Researchers investigating the impact of one CGM system (Abbott's FreeStyle Libre) reported an average HbA1c drop from 8.5 per cent to 7.7 per cent over six months, bringing levels closer to the recommended target of 7 per cent.
The expanded subsidy will have a profound impact on the health system's ability to manage a disease that costs it more than half a billion dollars each year.
The March budget also saw funding announced for reviewing and reprogramming neurostimulators for chronic pain by video conference, as well as new Medicare Benefits Schedule item numbers for remote programming and monitoring technology for deep brain stimulation and cardiac internal loop recorders. This will support remote management of heart, chronic pain and neurological conditions.
Ensuring patients can access these solutions regardless of their socio-economic status or location is key to not just personal, but public health benefits being fully realised.
However, we must tackle other barriers including training, governance, connectivity and establishing centralised systems to track data to achieve practical integration of this technology into the health system at scale.
We are facing one of the largest backlogs of care our modern health system has ever experienced.
Returning to pre-pandemic settings won't be sufficient; the lag will be felt in rural care the most. The health crisis that could emerge beyond the current one would be dire; delayed diagnoses and neglect of deadly conditions will take a toll.
Progress in technology and changes in healthcare practice over the past two years has enabled us to build better connected, nimbler rural and remote health systems.
We must hasten the speed at which we address the equity gap in rural care enlarged by the pandemic. Technology can be the catalyst.
- Dr Ewen McPhee is immediate past president, Australian College of Rural and Remote Medicine; Dr Ken Wanguhu is a rural GP in South Australia; Dr Phillip Tideman is clinical director of the Integrated Cardiovascular Clinical Network SA; Dean Whiting is CEO, Pathology Technology Australia.