General practice utilisation of Medicare Benefits Schedule items to support the care of older patients: findings from the REDIRECT study
Lyle R. Turner A , Christopher Pearce A B , Bianca Brijnath C , Colette Browning D , Judy Lowthian E F , Marianne Shearer G and Danielle Mazza A H
+ Author Affiliations
- Author Affiliations
A Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
B Melbourne East General Practice Network (trading as Outcome Health), 1/5 Lakeside Drive, Burwood East, Vic. 3151, Australia.
C National Aging Research Institute (NARI), 34–48 Poplar Road, Parkville, Vic, 3052, Australia.
D Shenzhen International Institute for Primary Health Care Research, Shenzhen, Guangdong, P.R. China.
E Bolton Clarke, 31 Alma Road, St Kilda, Vic. 3182, Australia.
F Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia.
G Gippsland Primary Health Network, 16 Kirk Street, Moe, Vic. 3825, Australia.
H Corresponding author. Email: danielle.mazza@monash.edu
Australian Journal of Primary Health 24(1) 54-58 https://doi.org/10.1071/PY17047
Submitted: 13 April 2017 Accepted: 29 August 2017 Published: 8 November 2017
Abstract
Medicare Benefits Schedule (MBS) items designed to support the wellbeing of older people may reduce unnecessary emergency department utilisation, however it is unclear to what extent such items are used. This study examined general practitioner (GP) utilisation of these MBS items through an analysis of the Melbourne East Monash General Practice Database (MAGNET), which contains information collected from GP clinics within the inner east Melbourne region. Sociodemographic and MBS claim data were extracted for patients aged ≥75 years attending a GP between 2005 and 2012. Utilisation of 75+ Health Assessments, General Practitioner Management Plans (GPMP), Team Care Arrangements (TCAs) or reviews, or Medication Management Reviews (MMRs) was assessed. There were 12 962 (60.6%) patients assigned at least one of the MBS items. The highest level of claiming was for GPMPs (n = 4754; 35.8%) and TCAs (n = 4476; 33.7%), with MMRs having the lowest use (n = 1023; 6.8%). Examination of GP and patient barriers to the uptake of these items is needed, along with a greater understanding as to whether those most at risk of hospitalisation are receiving these services. Strategies that support capacity to implement these items are also required.
References
Australian Bureau of Statistics (2006) An introduction to Socio-Economic Indexes for Areas (SEIFA). ABS Catalogue Number 2039.0. ABS, Canberra, ACT, Australia.Australian Institute of Health and Welfare (2014a) Australian hospital statistics 2013–14: emergency department care. Health Services number 58. Catalogue Number HSE 153. AIHW, Canberra, ACT, Australia.
Australian Institute of Health and Welfare (2014b) Australia’s health 2014. Australia’s Health Series 14. Catalogue number AUS 178. AIHW, Canberra, ACT, Australia.
Caughey GE, Vitry AI, Ramsay EN, Gilbert AL, Shakib S, Ryan P, Esterman A, McDermott RA, Roughead EE (2016) Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes. Internal Medicine Journal 46, 1430–1436.
| Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2svnsVOitw%3D%3D&md5=cc5e36c893903681c9d48a55f030f7caCAS |
Comino EJ, Islam MF, Tran DT, Jorm L, Flack J, Jalaludin B, Haas M, Harris MF (2015) Association of processes of primary care and hospitalisation for people with diabetes: a record linkage study. Diabetes Research and Clinical Practice 108, 296–305.
| Association of processes of primary care and hospitalisation for people with diabetes: a record linkage study.Crossref | GoogleScholarGoogle Scholar |
Department of Health (2014a) Chronic disease management – provider information. (Commonwealth of Australia: Canberra, ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-factsheet-chronicdisease.htm [Verified September 2016]
Department of Health (2014b) Health assessment for people aged 75 years and older. (Commonwealth of Australia: Canberra, ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare_mbsitem_75andolder [Verified September 2016]
Flores-Mateo G, Violan-Fors C, Carrillo-Santisteve P, Peiro S, Argimon JM (2012) Effectiveness of organizational interventions to reduce emergency department utilization: a systematic review. PLoS One 7, e35903
| Effectiveness of organizational interventions to reduce emergency department utilization: a systematic review.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xntlegu7o%3D&md5=f9de81db2049e9a3e08e3f8e259f5cfdCAS |
Fountaine T, Bennett CC (2016) Health care homes: lessons from the Diabetes Care Project. The Medical Journal of Australia 205, 389–391.
| Health care homes: lessons from the Diabetes Care Project.Crossref | GoogleScholarGoogle Scholar |
Hamirudin AH, Ghosh A, Charlton K, Bonney A, Walton K (2015) Trends in uptake of the 75+ health assessment in Australia: a decade of evaluation. Australian Journal of Primary Health 21, 423–428.
| Trends in uptake of the 75+ health assessment in Australia: a decade of evaluation.Crossref | GoogleScholarGoogle Scholar |
Holden L, Williams ID, Patterson E, Smith JW, Scuffham PA, Cheung L, Chambers R, Golenko XA, Weare R (2012) Uptake of Medicare chronic disease management incentives - a study into service providers’ perspectives. Australian Family Physician 41, 973–977.
Hubbard RE, Peel NM, Scott IA, Martin JH, Smith A, Pillans PI, Poudel A, Gray LC (2015) Polypharmacy among inpatients aged 70 years or older in Australia. The Medical Journal of Australia 202, 373–377.
| Polypharmacy among inpatients aged 70 years or older in Australia.Crossref | GoogleScholarGoogle Scholar |
Joe A, Lowthian JA, Shearer M, Turner LR, Brijnath B, Pearce C, Browning C, Mazza D (2016) After-hours medical deputising services: patterns of use by older people. The Medical Journal of Australia 205, 397–402.
| After-hours medical deputising services: patterns of use by older people.Crossref | GoogleScholarGoogle Scholar |
Lowthian JA, Jolley DJ, Curtis AJ, Currell A, Cameron PA, Stoelwinder JU, McNeil JJ (2011) The challenges of population ageing: accelerating demand for emergency ambulance services by older patients, 1995–2015. The Medical Journal of Australia 194, 574–578.
Lowthian JA, Smith C, Smit PD, Stoelwinder JU (2013) Why older patients with lower clinical urgency choose to attend the emergency department. Internal Medicine Journal 43, 59–65.
| Why older patients with lower clinical urgency choose to attend the emergency department.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38nnsVWrsA%3D%3D&md5=5c60fdc045200402f805d1d800b7a2f8CAS |
Masso M, Bezzina AJ, Siminski P, Middleton R, Eagar K (2007) Why patients attend emergency departments for conditions potentially appropriate for primary care: reasons given by patients and clinicians differ. Emergency Medicine Australasia 19, 333–340.
| Why patients attend emergency departments for conditions potentially appropriate for primary care: reasons given by patients and clinicians differ.Crossref | GoogleScholarGoogle Scholar |
Mazza D, Pearce C, Turner LR, De Leon-Santiago M, McLeod A, Ferriggi J, Shearer M (2016) The Melbourne East Monash General Practice Database (MAGNET): using data from computerised medical records to create a platform for primary care and health services research. Journal of Innovation in Health Informatics 23, 523–528.
| The Melbourne East Monash General Practice Database (MAGNET): using data from computerised medical records to create a platform for primary care and health services research.Crossref | GoogleScholarGoogle Scholar |
Mazza D, Pearce C, Joe A, Turner LR, Brijnath B, Browning C, Shearer M, Lowthian J (2017) Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study. Australian Health Review
| Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study.Crossref | GoogleScholarGoogle Scholar | [Published online early 20 February 2017].
Naughton C, Bennett K, Feely J (2006) Prevalence of chronic disease in the elderly based on a national pharmacy claims database. Age and Ageing 35, 633–636.
| Prevalence of chronic disease in the elderly based on a national pharmacy claims database.Crossref | GoogleScholarGoogle Scholar |
Newland J, Zwar N (2006) General practice and the management of chronic conditions – where to now? Australian Family Physician 35, 16–19.
Takach M (2016) Policy levers key for primary health care organizations to support primary care practices in meeting medical home expectations: comparing leading states to the Australian experience. Population Health Management 19, 357–367.
| Policy levers key for primary health care organizations to support primary care practices in meeting medical home expectations: comparing leading states to the Australian experience.Crossref | GoogleScholarGoogle Scholar |
Vitry AI, Roughead EE, Ramsay EN, Ryan P, Caughey GE, Esterman A, Shakib S, Gilbert AL, McDermott R (2012) Chronic disease management: does the disease affect likelihood of care planning? Australian Health Review 36, 419–423.
| Chronic disease management: does the disease affect likelihood of care planning?Crossref | GoogleScholarGoogle Scholar |
Westbrook JI, Georgiou A, Black D, Hordern A (2011) Comprehensive medical assessments for monitoring and improving the health of residents in aged care facilities: existing comprehensive medical assessments coverage and trial of a new service model. Australasian Journal on Ageing 30, 5–10.
| Comprehensive medical assessments for monitoring and improving the health of residents in aged care facilities: existing comprehensive medical assessments coverage and trial of a new service model.Crossref | GoogleScholarGoogle Scholar |
White L, Klinner C, Carter S (2012) Consumer perspectives of the Australian Home Medicines Review Program: benefits and barriers. Research in Social & Administrative Pharmacy 8, 4–16.
| Consumer perspectives of the Australian Home Medicines Review Program: benefits and barriers.Crossref | GoogleScholarGoogle Scholar |
Wickramasinghe LK, Schattner P, Hibbert ME, Enticott JC, Georgeff MP, Russell GM (2013) Impact on diabetes management of general practice management plans, team care arrangements and reviews. The Medical Journal of Australia 199, 261–265.
| Impact on diabetes management of general practice management plans, team care arrangements and reviews.Crossref | GoogleScholarGoogle Scholar |
Wilkinson D, McElroy H, Beilby J, Mott K, Price K, Morey S, Best J (2003) Are socio-economically disadvantaged Australians making more or less use of the Enhanced Primary Care Medicare Benefit Schedule item numbers? Australian Health Review 26, 43–49.
| Are socio-economically disadvantaged Australians making more or less use of the Enhanced Primary Care Medicare Benefit Schedule item numbers?Crossref | GoogleScholarGoogle Scholar |
