Effects of the Medicare enhanced primary care program on primary care physician contact in the population of older Western Australians with chronic diseases
David A. J. Gibson A D , Rachael E. Moorin A B , David B. Preen A , Jon D. Emery C and C. D’Arcy J Holman AA The University of Western Australia, School of Population Health (M431), 35 Stirling Highway, Crawley, WA 9006, Australia. Email: rachael.moorin@uwa.edu.au; david.preen@uwa.edu.au; dholman@meddent.uwa.edu.au
B Curtin University, Health Innovation Research Institute, Centre for Population Health Research, GPO Box U1987, Perth, WA 6845. Australia.
C University of Western Australia, 328 Stirling Highway, Claremont, WA 6010, Australia. Email: jon.emery@uwa.edu.au
D Corresponding author. Email: dgibson@meddent.uwa.edu.au
Australian Health Review 35(3) 334-340 https://doi.org/10.1071/AH09852
Submitted: 29 October 2009 Accepted: 4 November 2010 Published: 25 August 2011
Abstract
Objective. Assess uptake of Medicare’s enhanced primary care (EPC) services in Western Australia (WA) in 2001 to 2006, evaluating effect of EPC services on the regularity of contact with general practitioners (GPs) in patients aged 65+ years.
Method. Whole-population cohort study using linked routinely collected health service data from State and Federal health databases. Analyses include age-standardised rate of EPC services, odds of EPC utilisation relative to other GP services using logistic regression, and total GP service regularity pre- and post-implementation of the EPC program.
Results. EPC services provided to WA seniors increased 345% 2001 to 2006, comprising an increasing proportion of the total GP services (1.1 to 3.6%). Uptake of EPC services accelerated abruptly after 2004 due to greater use of ‘care plans’. EPC services were associated with a history of chronic disease, especially type 2 diabetes (OR = 1.74, 95% CI 1.66–1.82). Regularity of total GP services was improved with any EPC service exposure, with greater improvement occurring in the presence of annual EPC service exposure.
Conclusions. EPC item uptake responded favourably to item changes from Medicare Australia. Prior exposure to EPC items increased the regularity of GP services, an outcome inversely associated with chronic disease progression.
What is known about the topic? The Australian Federal government has invested substantial funds (over $200 million in 2007–08 alone) in the enhanced primary care (EPC) program with the intention of improving patient outcomes, specifically aged patients and those suffering from chronic disease. The EPC program uses high value Medicare items to incentivise GPs to engage in long-term planned care. However, limited research has examined the effect of this program on patient service utilisation and outcomes.
What does this paper add? This paper provides a whole-population perspective on the EPC utilisation trends from 2001 to 2006 for Western Australian residents over 65 years of age. The paper then examines the likelihood of using the EPC program on the basis of calendar year, sex, age and chronic disease history. A comparison of the regularity of GP service utilisation for those exposed to the EPC program is also made.
What are the implications for practitioners? The adjustments made to the EPC program in 2004, after feedback from GPs, appears to have substantially increased the utilisation of the program. Additionally, patients suffering from several different chronic diseases are more likely to be exposed to the EPC program. Exposure to the EPC program also appears to provide an improvement in regularity of service utilisation which has been associated with improved outcomes in the literature.
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