Wednesday, 22 February 2023

Covid and the rural/urban divide

 We're both down with Covid at the moment, but we're recovering well.

However, initially J seemed to be struggling a little so we decided to get investigate getting antivirals to aid her recovery.

Antivirals are most effective taken within five days of the onset of an infection. As we came down with Covid at the weekend when the doctors's office and the pharmacy was closed that reduced our window to three days.

In Australia, you have to meet certain criteria to get antivirals, and you have to have a teleappointment with a GP once you have a positive test result. Most doctors will charge a consultation fee for the teleappointment,

Your GP then does his doctor thing, says you can have them (they are massively subsidised by the way, the sticker price is around a thousand bucks, but the subsidised price is under $10). He then sends an e-script to a pharmacy, they dispense them and organise delivery and you pay over the phone.

This is a good model, providing you are reasonably well off and you live in a big city, as does 80% of the population. 

And we could see how this would have worked in Canberra where we used to live. If our local GP had been unavailable, we'd have called one of these big medical service companies, they would have prescribed the antivirals, sent the script to one of the big 24x7 pharmacies, who would have processed the script and put the medication in an Uber. Possibly not the cheapest way of doing it, but we would have had same day service.

And let's be clear here, while we're  by no means wealthy, we're middle class and well enough off to be able to absorb the extra costs into our weekly budget without too much of a problem. For a lot of people the cost of the teleappointment and the Uber would be a step too far.

However we now live rural, and it's a different story.

No one is being blamed here, what we experienced was an unfortunate sequence of events. 

In the town we live in, there is one medical practice and one small pharmacy.

Getting a teleappointment was reasonably quick, and because they had J's medical history on file, getting an e-script was simple and straightforward.

Getting the antivirals was a different story. The pharmacy had run out of stock, and would not have them back in until the following day (remember our reduced window due to the weekend)

Our doctor did say that until the previous week he hadn't written a script for antivirals for weeks, and that they'd had a sudden spike in demand. He did offer to send the script to a pharmacy in a nearby larger town that he knew had stock if we had someone to collect it for us. 

There are no Ubers in the country and anyway, it would be an 80km round trip.

Given that we were both too sick to drive at this stage, it might as well have been on Mars.

There was a further complication in that. for some unknown reason, the pharmacy's escript machine was refusing connections. How it was resolved I don't know, but the two buildings are only 200m apart, so at worst, I guess they could have sent someone round with a sheaf of printouts.

By the next morning a call to the pharmacy confirmed they had J's script and that they had enough in that day's courier delivery to fill the script, and indeed  by 1430 that afternoon we had a knock on the door and a package on the doorstep.

Everything worked out well but it revealed problems with the delivery of time critical medications in rural areas. 

Obviously a small rural pharmacy can't maintain the stock levels of a big city pharmacy, so when there's a spike in demand they run out, just as they never have stock of more rarely used medications and order them in.

And in the country, pharmacies routinely close at 12.30 on a Saturday and don't open again to the Monday.

And in a sense we're our own worst enemies.

Because we know these limitations we work round them, for example, if J's rheumatologist gives her a script we usually get it filled in Melbourne or Albury, as we know it will take the local pharmacy anything from 24 to 48h to order stuff in.

Most times it doesn't matter. This time it did.

What it also shows is that big city models don't really work in rural and regional Australia. Ther's also the question about the cost of access - while the medications are subsidised, other parts of the piece are not.

And while we live rurally, where we live is not really remote. While it's a 40km drive, we have access to an intercity train line and the Melbourne Sydney freeway and there are some reasonably large regional towns within less than an hour's drive.

Further west, where things are altogether sparser, it could make a difference to someone's chance of a quick recovery ...

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