The impact of covid-19 on a rural hematology outreach service, an australian experience

ABSTRACT

Background: The COVID-19 pandemic has had widespread and drastic impacts on healthcare delivery across the world, aside from the direct effects of the virus itself. Patients in rural areas represent a particularly vulnerable population who may be heavily impacted by changes to healthcare provision. Griffith is a regional city in New South Wales, Australia with a fortnightly outpatient outreach hematology service provided by visiting hematologists travelling by plane from St Vincent's Hospital in Sydney. Hematologists were abruptly unable to continue regular in-person visits to Griffith after the COVID-19 pandemic caused flight disruptions and travel bans in April 2020. Rapid shifts to telemedicine consultations for remote specialist patient management were imposed due to the travel changes, supported by a pre-existing hematology-specific integrated and unified electronic health record between the two sites as previously reported1. This system offered the ability to continue the safe prescribing, monitoring and multidisciplinary management of haematology patients including those with malignant diseases. Aims: To review the impacts of the COVID-19 pandemic on a rural hematology outreach service, including on clinical service activity and patient transfer rates to the metropolitan tertiary referral centre. Methods: We reviewed the Griffith hematology outreach service activity for the 12 month period before and following the COVID-19 pandemic began significantly impacting rural Australian health services by causing flight cancellations and reliance on telemedicine reviews alone. Data was collected for the time periods April 2019-March 2020 and April 2020- March 2021 inclusive [remaining data to be presented]. Clinical service activity and patient admission rates to the metropolitan tertiary referral centre were assessed. Results: Prior to the pandemic, an average of 39 patients were seen in the Griffith clinic each month, compared to an average of 47 per month after the change to telemedicine, Figure 1. The number of new patient consultations performed increased over time, from 64 new patient reviews to 79 from April 2020. The St Vincent's Hospital hematology clinic service was similarly able to sustain it's activity with increases seen in both total and new patient reviews, increasing by 12% and 15% respectively. There was no increase seen in the number of hematology patients from the Griffith region needing treatment at the tertiary referral centre due to disruptions in care. In the 12 months prior to the service disruption (April 2019- March 2020), 18 patients were treated or required hematological investigation at the tertiary referral centre at St Vincent's Hospital in Sydney, compared to nine patient over the 10 month period following. Summary/Conclusion: We demonstrate how a rural outreach hematology service was able to continue with minimal disruption after the COVID-19 pandemic caused an abrupt transition to exclusively remote patient reviews and chemotherapy management. The use of an integrated digital platform shared between the two sites allowed the remote telehealth service to be maintained. Significant increases in rural patients requiring transfer or admission to the tertiary referral centre in Sydney were not seen. With continued uncertainty and unpredictable flight changes, we demonstrate long term and sustainable adjustments are feasible and necessary to serve rural populations from potentially detrimental changes to already fragile health services.