Ka Ora Telecare, a national after-hours telehealth service for rural Aotearoa New Zealand: a descriptive cross-sectional evaluation with particular attention to equity of access and outcomes.

INTRODUCTION: Rural communities in Aotearoa New Zealand have reduced access to primary care, particularly after hours, with greater impact on Māori, Pacific peoples and those in areas of higher deprivation. Ka Ora Telecare is a national after-hours telehealth service established to address these gaps without replacing local services.

AIM: This study aims to describe service use and clinical outcomes for Ka Ora, with attention to rurality, ethnicity and socioeconomic position.

METHODS: A cross-sectional descriptive evaluation of routinely collected, de-identified, aggregated service data, with the consultation as the unit of analysis, was performed. Variables were ethnicity (prioritised), age band, Community Services Card status, deprivation quintile, rurality by the Geographical Classification for Health (GCH), provider type and clinical outcome. Analysis was descriptive.

RESULTS: Across the 24 month study period, 69,337 consultations carried a valid GCH code: 63.1% in R1 (rural, close to an urban centre), 27.1% in R2 and 5.6% in R3. Māori representation fell from 22.5% in R1 to 16.8% in R3, and Pacific from 3.8% to 1.1%. Of 16,369 clinician-led consultations, 88% were resolved or partially resolved via telehealth and 8% required same-day escalation. Outcomes were similar across ethnic groups, and Māori and Pacific use was concentrated in higher deprivation quintiles.

DISCUSSION: Ka Ora is functioning as a useful component of the rural primary care system, reaching higher-deprivation populations. Use is concentrated in less remote rural communities, and Māori and Pacific representation declines with remoteness even though Māori form a larger share of the population in more remote areas. Whether use is proportionate to need cannot be determined from service-level data.