Care planning and adherence to diabetes process guidelines: Medicare data analysis
Akuh Adaji A C , Peter Schattner A , Kay Margaret Jones A , Bronwyn Beovich A and Leon Piterman BA Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. Email: peter.schattner@monash.edu, kay.jones@monash.edu, bronwyn.beovich@monash.edu
B Monash University, Building 901, 100 Clyde Road, Berwick, Vic. 3806, Australia. Email: leon.piterman@monash.edu
C Corresponding author. Email: akuh.adaji@monash.edu
Australian Health Review 37(1) 83-87 https://doi.org/10.1071/AH11136
Submitted: 8 January 2012 Accepted: 22 May 2012 Published: 19 November 2012
Abstract
Objective. To test the association, in patients with a diagnosis of diabetes I and II, between having or not having a care plan, (i.e. General Practice Management Plans (GPMPs),Team Care Arrangements (TCAs)), and having the recommended number of biochemical checks according to the diabetes Annual Cycle of Care guideline. The checks comprised HbA1c, HDL cholesterol and urinary microalbumin.
Methods. Chi-square analysis of retrospective group data obtained from the Medicare database (from ‘billing’ patterns only).
Results. The creation of GPMPs was associated with general practitioners (GPs) requesting checks for HbA1c (59.7%), HDL cholesterol (36.9%) and microalbumin (50.8%) for diabetes patients in accordance with guideline recommendations. Although the introduction of multidisciplinary care via a TCA was associated with an increase in the frequency of HbA1c checks (61.3%) in accordance with the guidelines, there was a reduction in the number of HDL cholesterol (23.7%) and microalbumin (36.8%) checks. The group with no care plans had the lowest association with HbA1c (47.8%), HDL cholesterol (19.7%) and microalbumin (29.3%) checks that met guideline requirements for diabetes.
Conclusions. The use of GPMPs showed strong association with increased testing of process measures that met guideline requirements for diabetes. Further research is needed to understand the value and benefits of TCAs in promoting adherence to diabetes guidelines.
What is known about the topic? Research suggests that care planning is associated with increased adherence by GPs to some of the processes of care stipulated in diabetes guidelines.
What does the paper add? This study examines Australia-wide data obtained from Medicare. The findings demonstrated strong association between care planning and the process measures examined in this study. In contrast to previous studies, multidisciplinary team involvement via a TCA appeared to be less important than a GPMP in promoting adherence to process measures.
What are the implications for practitioners? GPs should continue to provide structure care to patients via General Practice Management Plans.
References
[1] Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002; 288 1775–9.| Improving primary care for patients with chronic illness.Crossref | GoogleScholarGoogle Scholar | 12365965PubMed |
[2] de Sonnaville JJ, Bouma M, Colly LP, Deville W, Wijkel D, Heine RJ. Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study. Diabetologia 1997; 40 1334–40.
| Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FkvFaqtw%3D%3D&md5=40406718e6b59ab01ff5df6235fe8bddCAS | 9389427PubMed |
[3] Egger G, Binns AF, Rossner SR. The emergence of “lifestyle medicine” as a structured approach for management of chronic disease. Med J Aust 2009; 190 143–5.
| 19203313PubMed |
[4] Diabetes management in general practice: guidelines for type 2 diabetes (2011/12). Diabetes Australia and RACGP 2011. Available at http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/Diabetesmanagement/201107diabetesmanagementingeneralpractice.pdf [Verified 12 September 2012].
[5] Powell Davies G, Williams AM, Larsen K, Perkins D, Roland M, Harris MF. Coordinating primary health care: an analysis of the outcomes of a systematic review. MJA 2008; 188 S65–8.
| 18429740PubMed |
[6] Primary Care Items MBS. History of key MBS primary care initiatives 1999–2010. Australian Government Department of Health and Ageing 2011. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-History [Verified 12 September 2012].
[7] Chronic disease management (CDM) Medicare items Fact sheet. Australian Government Department of Health and Ageing 2011. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-factsheet-chronicdisease.htm [Verified 12 September 2012].
[8] Shortus TD, McKenzie SH, Kemp LA, Proudfoot JG, Harris MF. Multidisciplinary care plans for diabetes: how are they used? MJA 2007; 187 78–81.
| 17635087PubMed |
[9] Zwar NA, Hermiz O, Comino EJ, Shortus T, Burns J, Harris M. Do multidisciplinary care plans result in better care for patients with type 2 diabetes? Aust Fam Physician 2007; 36 85–9.
| 17252093PubMed |
[10] Segal L. Multidisciplinary care plans. [comment][author reply] Aust Fam Physician 2007; 36 679
| 17915373PubMed |
[11] Australian Bureau of Statistics 2007. Population, Australian States and Territories: Catalogue no. 3239.0.55.001. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3239.0.55.001. [Verified 12 September 2012].
[12] Diabetes prevalence in Australia: an assessment of national data sources. Australian Institute of Health and Welfare: Canberra, 2009.
[13] Mant J. Process versus outcome indicators in the assessment of quality of health care. Int J Qual Health Care 2001; 13 475–80.
| Process versus outcome indicators in the assessment of quality of health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FktlWhtw%3D%3D&md5=2fdb85930053adaf38754a06c9fb37e4CAS | 11769750PubMed |
[14] Taylor MJ, Swerissen H. Medicare and chronic disease management: integrated care as an exceptional circumstance? Aust Health Rev 2010; 34 152–61.
| Medicare and chronic disease management: integrated care as an exceptional circumstance?Crossref | GoogleScholarGoogle Scholar | 20497727PubMed |
