COVID revealed potential of phone consultation easing clinics’ burden

Malta’s experience of the COVID pandemic led to a rise in telephonic consultations from 2020, mostly from patients aged 70 years and over. But doctors who analysed electronic patient records over the following two years said visits to health centres rose again after the pandemic.

Doctors and researchers carried out a quantitative analysis of patients’ use of government health centres in Malta during 2020-2022, the first time that such a comparative study was done.

Doctors Daniela Mifsud and Jurgen Abela, together with researchers Gianluca Ursino and Julia Zahra analysied patient records for two weeks during 2020 and 2022, namely a week in March (7-13) for all three years, as well as a week in August (3-9).

One hypothesis of the study was that throughout the peaks of the COVID-19 pandemic less people made use of government health centres for a medical review. The results of the quantitative analysis demonstrate a statistically significant rise in patients attending the health centres over the time period as restrictions related to the COVID-19 pandemic eased.

A second hypothesis was that patients made use of the government health centre services more frequently in winter when compared to summer.

However, this study – published in the Maltese Journal of Family Medicine – found a statistically significant increase in the use of health centre services during the summer when compared to winter.

“Over the years a trend was noted where, while telephone consultations were not popular in 2020, as the pandemic progressed patients started making use of telemedicine. As the pandemic restrictions eased, patients opted for face-to-face GP service more, with telephone consultations remaining a minority. Furthermore, it was quite interesting to note that the population subgroup that made use of telemedicine most were those aged 70 and over,” the authors said.

The doctors believe face-to-face consultations increased from 2020 to 2022 due to concerns related with morbidity and mortality of COVID-19. “The majority of patients raise more than one issue during a single consultation and thus it might be easier to do so in person rather than via telemedicine… Another possible explanation is that, as highlighted in a local study, hypertension is the most common comorbidity. Therefore, patients might request more face-to-face consultations to measure their blood pressure.”

They said educating patients about the use of telemedicine and that this can be fruitful beyond the pandemic by reducing the burden of local health centres as a rise in use of these community clinics have been noted over the past three years. “Further research is required to assess the public and general practitioners’ knowledge, perspectives, and attitudes on telemedicine and whether the implementation of telemedicine has reduced the workload on Maltese health centres.”

Primary healthcare is delivered in Malta through the publicly funded health service and a parallel running private health system in GP clincis and community pharmacies. The public sector is provided through ten health centres and a mix of community clinics. The three main health centres are located in Floriana, Mosta and Paola and are open 24 hours a day. The satellite health centres consist of Birkirkara, Rabat, Gżira, Qormi, Kirkop and Cospicua.

Results of the study

Throughout the two one-week study periods during 2020-2022, 25,398 patient encounters were recorded. Of these 52% of patients were female while 48% of patients were male. The commonest subgroup were patients aged over 70 years, itself composed of 12.3% females and 10% males.

Out of the 25,398 samples, 13,872 of patients visited a health centre in summer which resulted in a sample proportion of 0.55.

The government health centre which was used mostly was Mosta Health Centre (21.3%), followed by Paola Health Centre (19.5%) and Floriana (14.4%). The health centres which were used the least by patients was the Cospicua Health Centre (5.7%), followed narrowly by Qormi Health Centre (5.8%).

Most patients making use of the health centre service in Malta were from the Northern Harbour District (30.9%) followed by the Southern Harbour District (23.3%). On the other hand, patients residing in Gozo made up only 0.5% of patients using these clinics in Malta throughout the study period.

The electronic patient records also provided information on whether the consultation was face-to-face or telephone based. Out of 25,398 consultations, 17,152 (67.5%) were face- to-face whilst 8,246 (32.5%) were telephone consultations. Once again, the highest amount of telephone consultations was made within the Northern Harbour catchment area.

It was in the area of Gzira Health Centre that experienced more telephone consultations (51%) when compared to face-to-face clinic consultations (49%). However, the overall majority of patients still preferred face-to-face consultations when compared to telephone consultations.

“Over the years a trend was noted: while telephone consultations were not popular initially during 2020, as the pandemic went on patients became more aware and made use of telemedicine. Thereafter, the majority of patients opted for face-to-face consultations once again. Furthermore, it was quite interesting to note that the population subgroup that made most use of telemedicine was the 70+ group (37%),” the doctors said.

The date shows that the number of telemedicine consultations was quite high and contributes to some off-loading from face-to-face consultations at health centres.

“Without a doubt the COVID-19 pandemic has reshaped health care services and as a response to physical distancing and vulnerable patients, the use of telemedicine has emerged. Telemedicine reduces the amount of medical consultations resulting in saving time and cost of treatment for the patient and medical practitioner. It also helps to streamline the workflow of hospitals and clinics resulting in alleviation of the burden of in-clinic consultations,” the doctors said.