Impact of Enhanced Primary Care on equitable access to and economic efficiency of allied health services: a qualitative investigation
Terry P. Haines A C , Michele M. Foster B , Petrea Cornwell B , Jennifer Fleming B , Sean Tweedy B , Alison Hart B and Geoffrey Mitchell BA Allied Health Clinical Research Unit, Kingston Centre, Cnr Warrigal and Kingston Rds, Cheltenham, VIC 3192, Australia.
B University of Queensland, Therapies Lane, Brisbane, QLD 4072, Australia.
C Corresponding author. Email: terrence.haines@med.monash.edu.au
Australian Health Review 34(1) 30-35 https://doi.org/10.1071/AH09732
Submitted: 1 January 2009 Accepted: 18 November 2009 Published: 25 March 2010
Abstract
Objective. To evaluate new pathways to access allied health services introduced by the Enhanced Primary Care/Chronic Disease Management (EPC/CDM) initiative that may both increase or decrease equity to and efficiency in access.
Design. A qualitative study consisting of semi-structured in-depth interviews with a purposively selected group of allied health practitioners.
Participants and setting. Allied health practitioners in private practice in Queensland, Australia, from physiotherapy, occupational therapy, speech pathology, and exercise physiology backgrounds (n = 15).
Main outcome measures. Interviews focused upon several issues including how referrals are made under the EPC/CDM initiative and what happens for patients once their five allotted sessions are expended.
Results. The EPC/CDM initiative appeared to address two key barriers of access to allied health services – costs to patient of access and patient awareness of benefits. However, gap payments may still be deterring economically disadvantaged patients from attending.
Discussion. The EPC/CDM initiative is increasing access to allied health services for people with chronic diseases. However, it is evident that this initiative may still not be meeting the needs of those most disadvantaged economically, and may lead to duplication of efforts by allied health practitioners when patients move between private and public health care sectors.
What is known about the topic? Publicly funded subsidy of allied health services for people with chronic disease is a relatively new policy initiative in Australia. The success of such policy hinges on several factors, notably, its ability to improve equity of access to appropriate health care, generate improved health outcomes, and to do so efficiently.
What does this paper add? This paper demonstrates how health professionals and patients are actually using the Enhanced Primary Care/Chronic Disease Management initiative to access allied health services. The strengths and weaknesses of current policy identified will inform future policy development and funding decisions.
What are the implications for practitioners? Equitable access to allied health services for people with economic disadvantage is still limited due to gap payments. This initiative has facilitated patient exposure to the benefits of allied health services first hand, prompting some to continue paying for these services privately once the annual number of sessions permitted are exhausted.
[1]
[2]
[3]
[4] Foster MM, Mitchell G, Haines T, Cornwell P, Fleming J, Tweedy S. Does Enhanced Primary Care enhance primary care? Policy-induced dilemmas for allied health professionals. Med J Aust 2008; 188 29–32.
| PubMed |
[5] Beilby JJ. Primary care reform using a layered approach to the Medicare Benefits Scheme: unpredictable and unmeasured. Med J Aust 2007; 187 69–71.
| PubMed |
[6] Hickie IB, McGorry PD. Increased access to evidence-based primary mental health care: will the implementation match the rhetoric? Med J Aust 2007; 187 100–3.
| PubMed |
[7] Powell Davies G, Williams A, Larsen K, Perkins D, Roland M, Harris M. Coordinating primary health care: an analysis of the outcomes of a systematic review. Med J Aust 2008; 188(Suppl. 8): S65–8.
| PubMed |
[8] Sandelowski M. Whatever happened to qualitative description? Res Nurs Health 2000; 23 334–40.
| Crossref | GoogleScholarGoogle Scholar | PubMed | CAS |
[9] Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description – the poor cousin of health research? BMC Med Res Methodol 2009; 9 52.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[10] Pope C, Ziebland S, Mays N. Analysing qualitative data. BMJ 2000; 320 114–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed | CAS |
[11]
[12]
[13] Mitchell GK, Tieman JJ, Shelby-James TM. Multidisciplinary care planning and teamwork in primary care. Med J Aust 2008; 188(Suppl. 8): S61–4.
| PubMed |
[14] Skeat J, Morgan A, Nickless T. Playing by the rules: speech pathologists’ views about patient suitability for the Enhanced Primary Care Program. Aust Fam Physician 2009; 38 269–72.
| PubMed |
