CSIRO evaluates Healthdirect's Living with COVID program

A new report from the CSIRO, Australia's national science agency, evaluating Healthdirect Australia’s Living with COVID program has found it “a valuable public health initiative achieving positive early outcomes at the consumer and health system level”, noting its scalable structure helps provide the right care at the right time, achieve budgetary savings and support health literacy.

Drawing on digital, telephony and interoperable secure messaging resources, the program has successfully delivered timely care advice, assisting consumers to confidently manage their own care as well as connecting consumers with more acute symptoms with the right care at the right time. CSIRO recently delivered the agency’s Commonwealth-funded report, which evaluated the Living with COVID program’s performance between May and November 2022.

About the Living with COVID program

To ensure the Australian healthcare system was prepared to safely manage COVID-positive people in the community as restrictions were eased, the Australian Government announced several partnerships with primary care providers, States and Territories to support consumers through the post-acute phase of the national COVID Response. Funded jointly by participating States and Territories and the Commonwealth, Healthdirect developed a national approach to connect COVID-positive consumers with the right level of care based on their symptoms and risk factors – the ‘Living with COVID’ program.

Since commencing operations in February 2022, the Service has supported 53,663 COVID-positive Queenslanders, 83,936 COVID-positive South Australians and 52,263 COVID-positive Victorians (commenced July 22) seeking health advice and connected them to appropriate care. Since May 2022, it has also supported more than 30,930 New South Wales residents eligible for antivirals by connecting them to GPs, GPRCs and Aboriginal Medical Service treatment pathways.

CSIRO evaluated the following key activities within Qld, SA and NSW, for a specific time period:

• Inbound National Coronavirus Helpline (NCH): 24/7 inbound call centre to assess, triage and provide health advice based on symptoms and risk factors.
• GP secure messaging system: Notifying GPs of their COVID-positive patients and relevant risk factors, via standards-based secure messaging.
• Healthdirect’s digital tools: Support self-managed care at home with digital tools and information. 
• NSW Antiviral access pathway: facilitating rapid connection to care for at-risk patients.

“The Helpline delivered timely and appropriate advice and was effective in assisting consumers to manage their own care. The website provided many people with useful information on how to manage and recover from COVID and enabled access to the symptom checker.

“In NSW, the program is successfully coordinating timely access to GP services for people considered eligible for antiviral treatment,” the report said. “The program was effective as intended in connecting eligible consumers with antivirals within the recommended time window, many of whom were then able to self-manage after receiving their antivirals. This has important implications for potentially reducing the load on primary and tertiary care services.”

Attendees at MedInfo23 will have the opportunity to hear insights about the CSIRO evaluation, with Healthdirect Australia’s CEO, Bettina McMahon, set to take part in a panel discussion on the service with Dr Charlotte Hespe, RACGP Board Director and Faculty Chair NSW /ACT, and Dr Bronwyn Morrish, Assistant Secretary Primary Care Access at the Commonwealth Department of Health and Aged Care. Ms McMahon, Dr Hespe and Dr Morrish will discuss balancing clinical decision support with practitioner judgement and how forming productive partnerships and co-designing services with clinical peak bodies has been fundamental to the success of the Living with COVID program.

In a presentation on the healthcare ‘virtual front door’, Chief Delivery Officer Travis Hodgson will share how leveraging insights and capabilities built during the program has helped Healthdirect Australia shape and improve its service offering as the company continues to transform from a health advisory service to a facilitator of connected care.

Commonwealth CMO Professor Paul Kelly also endorsed the Living with COVID program.

“As we have learnt to live with COVID-19, a key element of continued protection against severe illness and death has been the availability of oral antivirals for those at higher risk of severe COVID-19,” Professor Kelly said. “It is crucial that those treatments are accessed quickly and it is very pleasing to see that the system we set up to assist in that outcome worked so well.”

“Most people with COVID-19 are now able to safely manage their symptoms at home. The Living with COVID service provides 24/7 information and advice for people to help them cope with their symptoms, minimise the risk of transmission, and if necessary, ensure people know when to call their doctor or go to hospital.

“This evaluation will inform further innovations in healthcare delivery as new technology becomes available and service needs continue to evolve.”

Secure messaging key to program’s success

A key element of the program’s success is Healthdirect Australia’s ability to send GPs secure digital notifications at scale that their patient has COVID-19, in addition to other clinically relevant information about the patient such as their symptoms and identified risk factors.

This service was designed to utilise clinics’ electronic secure messaging solutions rather than less secure communication methods such as facsimile.

During the early stages of the program, it was identified that not all practices had secure messaging enabled, so Healthdirect Australia, in conjunction with Primary Health Networks and the Australian Government Department of Health, worked with practice managers to enable them to receive notifications to their practice management software.

This activity included ensuring practice information is accurate and up to date in their secure messaging vendor’s directory and in the National Health Services Directory, which played a critical part in the end-to-end secure messaging service.

The service uses existing secure messaging systems as well as an innovative solution jointly designed with Telstra Health that uses Microsoft Azure cloud services and Lyniate’s Rhapsody middleware to integrate Healthdirect’s CRM with each of the messaging networks through standards-based APIs and HL7 messaging.

Easier access to antiviral treatments in NSW

NSW Health’s Clinical Director, Patient Experience and System Performance Support division, Dr Amith Shetty, said, the streamlined process allows for faster access to treatment.

“NSW health worked closely with the Healthdirect team to develop this service, which uses technology to connect a patient with a GP to fast-track assessment and prescribing of these lifesaving medications,” Dr Shetty said.

“NSW Health’s COVID-19 Patient Flow Portal connects with Healthdirect’s system notifying GPs of a patient’s result within an average of five hours, enabling patients to commence oral antiviral treatment within the recommended five-day timeframe.”

95% of appointments in NSW were conducted via telehealth, demonstrating the high uptake of this service option, while 79% of consumers were prescribed antivirals. More than half of consumers indicated they preferred to self-manage their care after receiving antivirals, indicating that access to them assisted with their management of COVID.

Clear budget savings in SA, Queensland

The CSIRO report included an economic analysis of the Living with COVID program in SA and Queensland, which compared the opportunity costs of treating patients who used the helpline to the opportunity costs that would have been incurred to treat the patients without the helpline.

“The economic evaluation found an estimated cost saving of between $1,472,339 and $4,138,438 for the period 2 May 2022 to 7 November 2022,” the study found. “This evaluation indicates that the helpline provides significant net benefits (or cost savings) by directing some callers to undertake less resource intensive and less costly treatment pathways than they would have undertaken without the helpline. The avoided costs of ED and GP presentations for these patients outweigh the costs of administering and using the helpline.”

In Queensland and SA, the call centre handled 90,867 calls during the evaluation period, with only 4% of calls abandoned. Meanwhile, 71% of participants surveyed rated their satisfaction with the helpline at 8 or above out of 10. And 94% of participants surveyed found some or all the information provided by call centre staff “clear and easy to understand”.

The National Coronavirus Helpline, managed by Healthdirect Australia, is the first and most comprehensive service to notify GPs through clinical secure messaging when their patients are COVID-19 positive and potentially eligible for antiviral treatments.