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South East Queensland Research Network
Incentives & Disincentives in General Practice
Chronic Disease Management
Dr. Ian Williams1Libby Holden2, Lily Cheung2,
Prof Liz Patterson2, Dr Jane Smith3, Xanthe Golenko2,, Robyn Chambers1
1: Camp Hill Medical Centre, 2: Griffith University, 3: Mudgeeraba Medical Centre
South East Queensland Research Network
Aims & Rationale
Aims:• To explore the impacts of chronic disease management (CDM) incentives
on general practice service providers• To identify opportunities of improvements to CDM care management and
optimal use of CDM incentives
Rationale:• Chronic disease responsible for 80% of total of burden of disease (1)• Only 50% of Australian CDM patients are receiving optimal care (2)• Chronic disease patients have complex needs (2)• Medicare CDM items are intended to provide incentives to GPs (3)• Problems with some Medicare items flagged by GPs in SEQRN
South East Queensland Research Network
Methods – study design
Exploratory, qualitative research design• Phase 1 – discipline specific focus groups• Phase 2 – in-depth interviews with staff from
nine practices• Phase 3 – extrapolation of findings and
collaboratively develop recommendation
South East Queensland Research Network
Methods: Sampling frame
Mix of:
• high, med, low incentives use
• Solo, 2-5, 6+ GPs
• non, part, full computerized
• Urban, outer metro, rural
South East Queensland Research Network
Methods: study participants
• Phase 1: range of individuals from eight different practices – discipline specific focus groups
• Phase 2: practice principal/or GP, Practice Manager & Practice Nurse from nine practices (only 4 same as practices from phase 1)
• Phase 3: yet to occur, plan to consult with all who participated in either phase 1 or 2
South East Queensland Research Network
Results: Study sample for phase 2
• Nine practices
• 6 Practice GP Principals, 3 GPs
• 7 Registered Nurses, 2 Enrolled Nurse
• 9 Practice Managers
South East Queensland Research Network
Results: Study Sample (cont)
age sex Yrs in GP Yrs in this practice
Qualifications
Practice Principal/GP
All >45 yr except 1 @ 35-44
5 males 4 females
All >10 yr except 1
3: <5yrs4: 6-20yr2: >20yrs
5 FRACGPAll MBBS
Practice Nurse
1: <35yr2: 35-44yr3: 45-54yr 2: >55yr
9 females All <10 yr except 2
All < 5 yrs except 2
6: RN2: EN1 unrecorded
Practice Manager
4: 35-44yr3: 45-54yr2: > 55yr
9 females 1: <10yr6: 10-20yr2: >20yr
6: < 10yr3: 10-20yr
3: nil 1: EN,1:RN1 Cert, 1: Dip, 1: BComm1:FAAPM
South East Queensland Research Network
Results: Overall issues mapped
South East Queensland Research Network
Results: key themes
• Medicare related issues• Financial viability• Patient outcomes• Training & support• Service models: ● staff roles ● systems
South East Queensland Research Network
Medical (level 2)
South East Queensland Research Network
Financial viability (level 2)
South East Queensland Research Network
Patient outcomes/impacts (level 2)
South East Queensland Research Network
Training & support (level 2)
South East Queensland Research Network
Service Models (level 2)
South East Queensland Research Network
Discussion: key messages
• Variation in practice structures, role delineation, software systems, and referral networks
• No apparent link between practice structure & CDM income
• Fine balance between patient care and practice viability
• Conflicting views on financial viability
South East Queensland Research Network
Discussion: key messages (cont)
• Improved patient outcomes reported by practice staff:
↟patient care monitoring ↡ acute care episodes
↟quality of care↟patient engagement in & expectations of care
South East Queensland Research Network
Discussion: key messages (cont)
• Medicare disincentives:◊ inconsistent &/or poor access to information on patient eligibility◊Need for improved systems at Medicare level before rolling out new items◊Need for consistent & transparent requirements from Medicare• Value of NPCC involvements for developing
standardised systems at practice level
South East Queensland Research Network
Discussion: key messages (cont)
• Variable barriers & enablers for nurses o Barrier - need for infrastructure (e.g.
confidential room) for RN role, time pressures, changing expectations e.g. bring in $ to cover wages
o Enabler – ↟satisfaction from ↟ patient interaction & ability to work positively re patient care, improved team approach & rapport building with GP
South East Queensland Research Network
Implications & Recommendations:
Medicare to consider: ◊ the value of CDM MBS items based on nursing care only e.g. education, preventative health care & monitoring role e.g. hypertension ◊ that systems & training is required before implement new Medicare items
South East Queensland Research Network
Implications & Recommendations:
Public / policy level debate on:
The funding of general practice based on quality of care outcomes rather than episodic care
South East Queensland Research Network
Acknowledgements:
• Study Participants
• RACGP funding
• Griffith PHCRED funding• South East Queensland Research Network
South East Queensland Research Network
References1. National Health Priority Action Council, National Chronic disease
Strategy, Australian Government Department of Health and Ageing, Editor. 2006, Australian Health Ministers' conference 2005.
2. Infante, F.A., et al., How people with chronic illnesses view their care in general practice: a qualitative study. Medical Journal of Australia, 2004. 181(2): p. 70-73.
3. Department of Health and Aging, Chronic Disease Management (CDM) Medicare Items: Q & As Updated with November 2006 MBS fees