Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners
Michele M. Foster A H , Petrea L. Cornwell B , Jennifer M. Fleming C , Geoffrey K. Mitchell D , Sean M. Tweedy E , Alison L. Hart F and Terry P. Haines GA Social Policy Unit, School of Social Work and Human Services, The University of Queensland, St Lucia, Qld 4072, Australia.
B Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland and Princess Alexandra Hospital, St Lucia, Qld 4072, Australia.
C The University of Queensland and Princess Alexandra Hospital, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Qld 4072, Australia.
D Discipline of General Practice, School of Medicine, Level 2, Edith Cavell Building, Royal Brisbane Hospital, Herston, Qld 4129, Australia.
E School of Human Movement Studies, The University of Queensland, St Lucia, Qld 4072, Australia.
F School of Social Work and Human Services, The University of Queensland, St Lucia, Qld 4072, Australia.
G Monash University and Southern Health, Kingston Centre, Cnr Warrigal and Kingston Roads, Cheltenham, Vic. 3192, Australia.
H Corresponding author. Email: m.foster@social.uq.edu.au
Australian Journal of Primary Health 15(4) 326-334 https://doi.org/10.1071/PY08065
Published: 26 November 2009
Abstract
Participation of allied health professionals (AHP) in the Enhanced Primary Care (EPC) program is increasing. However, access to allied health services is strictly delineated under the EPC program and AHP face unique practice realities in providing care to patients with chronic conditions. This paper examines the discretionary practices adopted by AHP in response to the realities at the policy–practice interface and situates the discussion within a description of their experiences with EPC. Semistructured telephone interviews were conducted with a purposive sample of fifteen AHP. Participants were selected from a larger cohort who responded to a questionnaire about EPC. The EPC program was perceived as a positive start, although some aspects were problematic. Participants reported that the restriction on the number of subsidised sessions was not conducive to providing a good allied health service to patients with complex care needs and remuneration was not commensurate with the nature and scope of treatment required. The AHP in this study spoke of the dilemma of wanting to assist patients but at the same time to operate a financially viable business. Moreover, their experience was that multidisciplinary team care was implied rather than reality. Abbreviated care practices, reasonable solutions for access, and entrepreneurial practices were strategies used to manage the policy–practice tensions.
Acknowledgements
The pilot study was funded by The University of Queensland. Thank you to all allied health who participated in the research and for the assistance and support of Speech Pathology Australia, OT Australia, Australian Physiotherapy Association, Australian Association for Exercise and Sports Science, and Australian Assocation of Social workers.
Cant R, Aroni R
(2007) Melbourne dietitians’ experience of Medicare policy on allied health services (strengthening Medicare; Enhanced Primary Care) in the first 12 months. Nutrition & Dietetics 64(1), 43–49.
| Crossref | GoogleScholarGoogle Scholar |
Foster M,
Mitchell G,
Haines T,
Tweedy S,
Cornwell P, Fleming J
(2008) Does Enhanced Primary Care enhance primary care? Policy-induced dilemmas for allied health professionals. The Medical Journal of Australia 188(1), 29–32.
| PubMed |
Harris M, Zwar N
(2007) Care of patients with chronic disease: the challenge for general practice. The Medical Journal of Australia 187(2), 104–107.
| PubMed |
Harrison S
(1995) A policy agenda for health care rationing. British Medical Bulletin 51(4), 885–899.
| PubMed |
CAS |
Lawton J,
Peel E,
Parry O,
Araoz G, Douglas M
(2005) Lay perceptions of type 2 diabetes in Scotland: bringing health services back in. Social Science & Medicine 60, 1423–1435.
| Crossref | GoogleScholarGoogle Scholar |
Murphy E,
Kinmouth AL, Marteau T
(1992) General practice based diabetes surveillance: the views of patients. The British Journal of General Practice 42, 279–283.
| PubMed |
CAS |
Oldroyd J,
Proudfoot J,
Infante F,
Davies G,
Bubner T,
Holton C,
Beilby J, Harris M
(2003) Providing healthcare for people with chronic illness: the views of Australian GPs. The Medical Journal of Australia 179, 30–33.
| PubMed |
Powell Davies G,
Hu W,
McDonald J,
Furler J,
Harris E, Harris M
(2006) Developments in Australian general practice 2000–2002: what did these contribute to a well functioning and comprehensive Primary Health Care System? Australia and New Zealand Health Policy 3, 1.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Schoen D,
Davis K,
DesRoches C,
Donelan K, Blendon R
(2000) Health insurance markets and income inequality: findings from an international health policy survey. Health Policy 51, 67–85.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
CAS |
Scott J
(2006) Is modern medicine at risk of losing the plot? The Medical Journal of Australia 4, 213–216.
Sims J,
Tacticos T,
Potiriadis M, Naccarella L
(2004) Evaluation of a program to assist usage of the Enhanced Primary Care case conferencing and care planning items: the allied health professionals’ viewpoint. Australian Journal of Primary Health 10(1), 72–77.
| Crossref |
Thoesen Coleman M, Newton K
(2005) Support self-management in patients with chronic illness. American Family Physician 72, 1503–1510.
| PubMed |
Tierman J,
Mitchell G,
Shelby-James T,
Currow D,
Fazekas B,
O’Doherty L,
Hegarty M,
Eriksson L,
Brown R, Reid-Orr D
(2007) Integration, coordination and multidisciplinary care: What can these approaches offer to Australian Primary Health Care? Australian Journal of Primary Health 13(2), 56–65.
| Crossref |
Wilson P,
Kendall S, Brooks F
(2007) The Expert Patients Programme: A paradox of patient empowerment and medical dominance. Health & Social Care in the Community 15(5), 426–438.
| PubMed |
