Drug and Alcohol Review - Clinician's Corner

“You don’t have to fly in and out anymore”: Expanding addiction medicine specialist care to regional NSW through TeleHUB

Australians living in regional and remote areas experience greater barriers to accessing specialist healthcare than their metropolitan counterparts. In addiction medicine, this inequity is particularly stark: 87% of addiction medicine specialists are based in urban settings, yet demand for alcohol and other drug (AOD) treatment increases with remoteness. Long travel times, workforce shortages and reliance on costly fly-in-fly-out (FIFO) models have contributed to extended wait times that can extend up to three months for specialist care.

In our Open Access paper, we describe the implementation and evaluation of the TeleHUB model, a telehealth approach designed to expand access to addiction medicine specialist care in regional New South Wales (NSW). Here we report on findings from Murrumbidgee Local Health District.
  

What is TeleHUB?

TeleHUB was designed as a shared-care model linking metropolitan-based addiction medicine specialists at St Vincent’s Hospital, Sydney, with regional AOD services via real-time videoconferencing. Importantly, TeleHUB did not aim to replace local services. Instead, it supplemented and collaborated with them:

• Metropolitan addiction medicine specialists provided consultations via telehealth.
• Local clinicians (e.g., nurses, health education officers) supported clients in-person during appointments.
• Administrative coordination was centralised to reduce burden on regional teams.

In Murrumbidgee (from August 2019), TeleHUB added extra specialist capacity alongside existing services.

Did it increase access?

The primary outcome was service capacity, measured as the number of scheduled addiction medicine specialist consultations per month before and after implementation.

Using interrupted time series analysis, Murrumbidgee saw a significant increase in scheduled consultations after TeleHUB was introduced. There was an estimated increase of 16.6 consultations per month (95% confidence interval 4.0–37.9; p<0.001). This represented a 46% increase compared with the pre-implementation average.

For clinicians working in regional settings, this is a critical finding: telehealth was not just an emergency substitute, but a sustainable model capable of increasing or maintaining specialist access.

What did clients and staff think?

Twelve clients and 16 clinicians were interviewed to explore acceptability.

Clients emphasised accessibility and reduced anxiety.

Many described feeling more comfortable speaking via videoconference than in person. For some, particularly those with prior incarceration or negative healthcare experiences, the screen created a sense of psychological safety. Telehealth reduced the need for long-distance travel: one participant had previously needed to fly to attend appointments. Reduced travel also meant reduced time, cost and stress burden, practical barriers that often deter engagement in specialist AOD care.

Staff highlighted increased accessibility and professional support.

Clinicians reported reduced wait times and improved access to specialist input. The shared-care approach fostered collaboration and professional development, with local clinicians feeling less isolated and better supported in complex cases. Concerns commonly raised in telehealth debates, such as impaired therapeutic rapport or technical barriers, did not emerge as major issues in this evaluation.

Why does this matter for clinicians?

For many regional services, addiction medicine specialist care is constrained by:

• Recruitment challenges.
• High workforce turnover.
• Costly FIFO arrangements.
• Geographic isolation.

TeleHUB demonstrates a practical, system-level response that:

• Expands specialist capacity without requiring permanent on-site recruitment.
• Reduces travel and accommodation costs.
• Maintains continuity of local therapeutic relationships.
• Strengthens shared-care between metropolitan and regional services.

Critically, clients did not need high digital literacy or personal devices; they attended appointments within their familiar local service, supported by local staff. This addresses a common equity concern in telehealth implementation.

Considerations and future directions

The study was conducted in districts with existing telehealth infrastructure, which may limit immediate scalability in under-resourced settings. Administrative data limitations are also acknowledged.

Nevertheless, this evaluation provides rare, rigorous Australian evidence, using interrupted time series methods, that telehealth can meaningfully improve access to addiction medicine specialist care in regional settings.

Future research should explore:

• Clinical outcomes beyond service capacity (e.g., retention, substance use outcomes).
• Cost-effectiveness compared to FIFO models.
• Expansion to other specialist disciplines within AOD care.
  
  

Take-home messages for practice

• Telehealth can be a viable, acceptable alternative, or supplement, to FIFO addiction medicine specialist services.
• Shared-care models strengthen both service capacity and clinician support.
• Reducing travel barriers may enhance engagement in specialist AOD care.
• Telehealth should be viewed not only as a pandemic response, but as a strategic workforce solution for regional Australia.

As inequitable workforce distribution continues to shape inequities in addiction care, models like TeleHUB offer a blueprint for rethinking how specialist expertise can reach communities where it is needed most.

Prepared on behalf of the Investigator Team by:

Krista Siefried

National Centre for Clinical Research on Emerging Drugs; National Drug and Alcohol Research Centre, UNSW Sydney; and Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia

The full paper is available Open Access:

Smylie CS, Moller CI, McWilliams L, Clifford B, Acheson L, Chambers M, Siefried KJ, Brett J, Shakeshaft A, Roberts DM, Corliss C, Rich J, Clark SC, Manzie R, Dunlop A, Speirs B, Kay-Lambkin F, Ezard N. Expanding Access to Addiction Medicine Specialist Care in Regional New South Wales, Australia Through Telehealth. Drug Alcohol Rev. 2026;45(1):e70101 https://doi.org/10.1111/dar.70101

Call for Papers

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