Please provide a feedback to my answer to this question below.

 

Find an example of a productive/technical efficiency improvement in the delivery of a health service.  This might be a published journal article or a report. Provide a brief summary of the paper, including the situation pre-improvement, a description of the measure that improved efficiency and a brief summary of the findings.  Have the findings from your efficiency improvement influenced practice or policy change  Explain, including any barriers to change.

 

Monash Health Refugee Health and Wellbeing clinic (MH RHW) affiliated with Monash Health one of the largest public healthcare providers in Victoria, Australia is funded by state and provides primary and specialist care by a multi-disciplinary team to asylum seekers and refugees. Refugees and humanitarian entrants have unique experiences that impact their persistent poor general health (AIHW, 2023). Multiple co-morbidities amongst this cohort along with multiple stressors of resettlement such as compromised living conditions, poor employment, language and healthcare access barriers are identified as health risks (Department of Health, 2023). In March 2020, with the spread of the COVID-19 pandemic the Australian government endorsed item numbers to telehealth services including telephone consultations via Medicare to minimise unnecessary in person contact (RACGP, 2023). Due to the high-risk and vulnerable nature of health outcomes  of the refugee cohort it was a priority to ensure their uninterrupted access to high-quality healthcare alongside the provision of COVID-19 related services (Kunin et al. 2022). Thus, MH RHW clinic opted the use of telephone healthcare delivery due to lack of access to technology necessary for telehealth consultation among its patients (). While rural and remote communities have had high rates of success in healthcare delivery via telephone in the past, there is a lack of evidence across different populations related to the applicability and acceptability of this mode of healthcare provision. Kunin et al. (2022) study evaluates the usage of telephone-based consultations in primary and specialist healthcare provision for refugee and asylum seeker cohort to inform the post COVID-19 service delivery.

Telephone consultations were seen a  workable solution to the pandemic situation in the provision of healthcare to this patient group. Patient accessibility in terms of quality of connection and ease of attendance to appointments and reduced travel costs were rated high (Kunin et al. 2022). The language barrier was overcome by routine use of interpreters with three-way telephone connection. High rates of acceptability were also noted from patient perspective. The clinician perspective generated slightly different outcomes (Kunin et al. 2022). Increased anxiety reported among clinicians due to risk of misdiagnosis, inadequate/incomplete risk assessments for mental health and vulnerable situations such as domestic violence. Changes to the distribution of the workload among the different professions increased burden. From a efficiency perspective telephone consultations were considered no more efficient than in-person service provision (Kunin et al. 2022). Routine telephone consultations for minor issues (ie. follow-up check-ups and scripts) gained efficiency, yet lack of ability of physical examinations was averse to efficiency. Factors such as increased wait-time for interpreters, additional administrative work and increased nursing staff workload infringed on efficiency. Thus, the study suggests viewing telephone health consultations/care provision as a useful means of providing certain types of care to this cohort of patients rather than it being the sole means of care provision post pandemic to afford healthcare efficiencies (Kunin et al. 2022).

 

References

Department of Health (12, April 2023). Refugee and asylum seeker health and wellbeing. https://www.health.vic.gov.au/populations/refugee-and-asylum-seeker-health-and-wellbeing

Australian Institute of Health and Welfare (07, February 2023). Refugee and humanitarian entrant health. https://www.aihw.gov.au/reports-data/population-groups/cald-australians/refugee-and-humanitarian-entrant-health

Department of Health (12, April 2023). Refugee and asylum seeker health and wellbeing. https://www.health.vic.gov.au/populations/refugee-and-asylum-seeker-health-and-wellbeing

Kunin, M., Ali, R., Yugusuk, C., Davism A. & McBride, J. (2022). Providing Care by Telephone to Refugees and Asylum Seekers: An Evaluation of Telephone Mode-of-Care in Monash Health Refugee Health and Wellbeing Clinic in Victoria, Australia. Health Services Insights, 15, 1-12. DOI:10.1177/11786329221134349

The Royal Australian College of General Practitioners (RACGP) (2023). Items for COVID-19 telehealth and phone services. https://www.racgp.org.au/running-a-practice/practice-resources/medicare/medicare-benefits-schedule/new-items-for-covid-19-telehealth-services.