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Ghasemiardekani M, Willetts G, Hood K, Cross W. The effectiveness of chronic disease management planning on self-management among patients with diabetes at general practice settings in Australia: a scoping review. BMC PRIMARY CARE 2024; 25:75. [PMID: 38429634 PMCID: PMC10905899 DOI: 10.1186/s12875-024-02309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Medicare provides significant funding to improve, encourage and coordinate better practices in primary care. Medicare-rebated Chronic Disease Management (CDM) plans are a structured approach to managing chronic diseases in Australia. These chronic disease care plans are intended to be a vehicle to deliver guideline-based / evidence-based care.. However, recommended care is not always provided, and health outcomes are often not achieved. This scoping review aimed to identify the specific components of CDM plans that are most effective in promoting self-management, as well as the factors that may hinder or facilitate the implementation of these plans in general practice settings in Australia. METHOD A comprehensive search was conducted using multiple electronic databases, considering inclusion and exclusion criteria. Two reviewers independently screened the titles and abstracts of the identified studies via Covidence, and the full texts of eligible studies were reviewed for inclusion. A data extraction template was developed based on the Cochrane Effective Practice and Organization of Care Group (EPOC) to classify the intervention methods and study outcomes. A narrative synthesis approach was used to summarize the findings of the included studies. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist. RESULTS Seventeen articles were included in the review for analysis and highlighted the effectiveness of CDM plans on improving patient self-management. The findings demonstrated that the implementation of CDM plans can have a positive impact on patient self-management. However, the current approach is geared towards providing care to patients, but there are limited opportunities for patients to engage in their care actively. Furthermore, the focus is often on achieving the outcomes outlined in the CDM plans, which may not necessarily align with the patient's needs and preferences. The findings highlighted the significance of mutual obligations and responsibilities of team care for patients and healthcare professionals, interprofessional collaborative practice in primary care settings, and regular CDM plan reviews. CONCLUSION Self-management support remains more aligned with a patient-centred collaboration approach and shared decision-making and is yet to be common practice. Identifying influential factors at different levels of patients, healthcare professionals, and services affecting patients' self-management via CDM plans can be crucial to developing the plans.
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Affiliation(s)
- Maryam Ghasemiardekani
- Institute of Health and Wellbeing. Federation University, Ballarat, Victoria, Australia.
| | - Georgina Willetts
- Institute of Health and Wellbeing. Federation University, Ballarat, Victoria, Australia
- Nursing and Practice Development Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Kerry Hood
- Institute of Health and Wellbeing. Federation University, Ballarat, Victoria, Australia
- Nursing and Practice Development Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Wendy Cross
- Federation University, Ballarat, Victoria, Australia
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Byles J, Cavenagh D, Bryant J, Mazza D, Browning C, O'Loughlin S, Sanson-Fisher R. Use of medical services by older Australian women with dementia: a longitudinal cohort study. Aust N Z J Public Health 2021; 45:497-503. [PMID: 34309976 DOI: 10.1111/1753-6405.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the use of Medicare-subsidised health services by women with and without dementia. METHODS Data from women of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models. RESULTS A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non-emergency GP attendances (short [<30 minutes] IRR=1.11 [1.07, 1.13]; long [>30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. CONCLUSIONS The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).
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Affiliation(s)
- Julie Byles
- Centre for Women's Health Research, The University of Newcastle, New South Wales
| | - Dominic Cavenagh
- Centre for Women's Health Research, The University of Newcastle, New South Wales
| | - Jamie Bryant
- Health Behaviour Research Group, The University of Newcastle, New South Wales
| | - Danielle Mazza
- Department of General Practice, Monash University, Victoria
| | | | | | - Rob Sanson-Fisher
- Health Behaviour Research Group, The University of Newcastle, New South Wales
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Hafiz N, Hyun K, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba TL, Halcomb E, Usherwood T, Redfern J. Gender Comparison of Receipt of Government-Funded Health Services and Medication Prescriptions for the Management of Patients With Cardiovascular Disease in Primary Care. Heart Lung Circ 2021; 30:1516-1524. [PMID: 33933363 DOI: 10.1016/j.hlc.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/11/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention. METHODS De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices. RESULTS Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43%; adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adjustment, only an antiplatelet medication or agent was less likely to be prescribed to women than men (44% vs 51%; adjusted OR [95% CI]: 0.84 [0.76, 0.94]). CONCLUSION Women were more likely to receive CDMPs but less likely to receive antiplatelet medications than men, no gender difference was observed in the receipt of mental health care. However, the receipt of the CDMPs and the mental health treatment consultations were suboptimal and better use of these existing services could improve ongoing CVD management.
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Affiliation(s)
- Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. https://twitter.com/HafizNashid
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Knight
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Charlotte Hespe
- The University of Notre Dame, School of Medicine, Sydney, NSW, Australia
| | - Clara K Chow
- Western Sydney Local Health District, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Sydney, NSW, Australia
| | - Robyn Gallagher
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - David L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences & Medicine, Bond University, Brisbane, Qld, Australia
| | - Mark Woodward
- University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Emily R Atkins
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Tracey-Lea Laba
- University of Technology Sydney Centre for Health Economics Research and Evaluation, Sydney, NSW, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Timothy Usherwood
- The George Institute for Global Health, Sydney, NSW, Australia; The University of Sydney, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
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Youens D, Moorin R, Harrison A, Varhol R, Robinson S, Brooks C, Boyd J. Using general practice clinical information system data for research: the case in Australia. Int J Popul Data Sci 2020; 5:1099. [PMID: 34164582 PMCID: PMC8188523 DOI: 10.23889/ijpds.v5i1.1099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
General practice is often a patient’s first point of contact with the health system and the gateway to specialist services. In Australia, different aspects of the health system are managed by the Commonwealth Government and individual state / territory governments. Although there is a long history of research using administrative data in Australia, this split in the management and funding of services has hindered whole-system research. Additionally, the administrative data typically available for research are often collected for reimbursement purposes and lack clinical information. General practices collect a range of patient information including diagnoses, medications prescribed, results of pathology tests ordered and so on. Practices are increasingly using clinical information systems and data extraction tools to make use of this information. This paper describes approaches used on several research projects to access clinical, as opposed to administrative, general practice data which to date has seen little use as a resource for research. This information was accessed in three ways. The first was by working directly with practices to access clinical and management data to support research. The second involved accessing general practice data through collaboration with Primary Health Networks, recently established in Australia to increase the efficiency and effectiveness of health services for patients. The third was via NPS MedicineWise’s MedicineInsight program, which collects data from consenting practices across Australia and makes these data available to researchers. We describe each approach including data access requirements and the advantages and challenges of each method. All approaches provide the opportunity to better understand data previously unavailable for research in Australia. The challenge of linking general practice data to other sources, currently being explored for general practice data, is discussed. Finally, we describe some general practice data collections used for research internationally and how these compare to collections available in Australia.
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Affiliation(s)
- D Youens
- School of Public Health, Curtin University, Perth, Australia
| | - R Moorin
- School of Public Health, Curtin University, Perth, Australia.,School of Population and Global Health, University of Western Australia
| | - A Harrison
- School of Public Health, Curtin University, Perth, Australia
| | - R Varhol
- School of Public Health, Curtin University, Perth, Australia
| | - S Robinson
- School of Public Health, Curtin University, Perth, Australia
| | - C Brooks
- Swansea University Medical School, Singleton Park, Swansea, UK
| | - J Boyd
- Health Systems & Economics, School of Public Health, Curtin University.,Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University
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Welberry H, Barr ML, Comino EJ, Harris-Roxas BF, Harris E, Dutton S, Jackson T, Donnelly D, Harris MF. Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia? BMC Health Serv Res 2019; 19:811. [PMID: 31699091 PMCID: PMC6836396 DOI: 10.1186/s12913-019-4663-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/21/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years. METHODS This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P&CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P&CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006-2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage. RESULTS Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years. CONCLUSIONS The use of GPMPs and/or TCAs in the CES area appears well-targeted towards those with chronic and complex care needs. There was no evidence to suggest that the use of GPMPs and /or TCAs has prevented hospitalisations in the CES region.
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Affiliation(s)
- Heidi Welberry
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW 2052 Australia
| | - Margo Linn Barr
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW 2052 Australia
| | - Elizabeth J. Comino
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW 2052 Australia
| | - Ben F. Harris-Roxas
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW 2052 Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW 2052 Australia
- Health Equity Research and Development Unit, Sydney Local Health District, NSW, Level 9, King George V Building, PO Box 374, Camperdown, NSW 2050 Australia
| | - Shona Dutton
- The Royal Australian & New Zealand College of Radiologists, Level 9, 51 Druitt Street, Sydney, NSW 2000 Australia
- Central and Eastern Sydney Primary Health Network, Tower A, L5, 201 Coward Street, Mascot, NSW 2020 Australia
| | - Tony Jackson
- South Eastern Sydney Local Health District, NSW Health, District Executive Unit, Locked Mail Bag 21, Tarren Point, NSW 2229 Australia
| | - Debra Donnelly
- Sydney Local Health District, NSW Health, Level 11, KGV Building, Missenden Road, Camperdown, NSW 2050 Australia
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW 2052 Australia
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Welberry H, Barr ML, Comino EJ, Harris-Roxas BF, Harris E, Harris MF. Increasing use of general practice management and team care arrangements over time in New South Wales, Australia. Aust J Prim Health 2019; 25:168-175. [DOI: 10.1071/py18113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022]
Abstract
The number of older people living with chronic health conditions is increasing in Australia. The Chronic Disease Management (CDM) items program was introduced to the Medicare Benefits Schedule (MBS) to encourage a more structured approach to managing patients with chronic conditions. Initial uptake was slow and recent research has suggested that uptake is decreasing. This paper examines: person MBS CDM claims in NSW between 2006 and 2014 — using baseline survey data (2006–09) from the Sax Institute’s 45 and Up Study linked to MBS and Death Registry data (2006–14) — and MBS CDM claims per 100000 population — using billing data sourced from the Medicare Australia Statistics website — to systematically examine any changes in uptake using a time-series analysis. After age adjustment, claims for initial plans increased from 11.3% in 2006 to 22.4% in 2014. Increases were also seen for allied health service claims (from 4.1% in 2006 to 20.8% in 2014) and for plan reviews (from 5.9% in 2006 to 16.0% in 2014). These increases were consistent with the MBS summary claims data. There is evidence that these plans are appropriately targeting those in most need; however, there is limited evidence of their effect. Claims for plan reviews, although increasing, are suboptimal and may indicate poor continuity of care.
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