Enhanced Primary Care pilot program benefits Type II diabetes patients

Abstract

Background. The Australian Government Medicare Enhanced Primary Care (EPC) initiative for chronic disease management (CDM) supports integrated allied health (AH) and general medical practitioner (GP) care. There are limited examples of how to operationalise this initiative in private practice, and minimal evidence of expected service utilisation or acceptability to patients. This paper reports on a 2007 Australian integrated GP/private sector AH pilot program, based on Medicare EPC guidelines for Type II diabetes.

Objectives. Describe how the pilot program was put in place (operationalised). Report on service utilisation and patient perspectives of the pilot program.

Methods. Pilot program: patients with Type II diabetes were referred to credentialed diabetes educators (CDEs), dietitians or podiatrists by their GP, via a Medicare-approved team care arrangement (TCA). Dietitians and CDEs operated on a sessional basis from GPs’ rooms, and podiatrists operated from their own clinics. All AH providers accepted the Medicare Plus rebate only, and provided guidelines-based care (focussed on patient education, disease ownership and self-management). Service utilisation was measured by the number and type of AH attendances per patient. Patient perspectives of the pilot program, and what they perceived they had gained from participation in it, were measured by semi-structured telephone interviews.

Results. An average of 2.3 AH consultations were consumed by 588 patients, of whom 59 were interviewed. Interviewed patients appreciated the ready and timely access to AH services at no additional cost, the integration of GP/AH care, and being actively involved in managing their disease. Approximately 60% of patients had never previously consulted an AH provider regarding diabetes. Interviewees perceived that collocated, integrated GP–AH care heightened their disease awareness, improved their knowledge of their disease and encouraged them to better self-manage. Most interviewees indicated that they did not require further AH assistance in the short term (having gained what assistance they needed), and ~60% interviewees indicated they would pay a gap fee for similar AH services in the future.

Conclusion. Integrated AH/GP guidelines-based care provided in GP clinics appears to be cost efficient. It has the potential to improve patient access to AH care, promote the role of integrated care in the management of Type II diabetes, and improve patient education and self-management.

What is known about the topic? There is a growing body of research on the effectiveness of multidisciplinary teams in the management of patients with chronic disease, in terms of promoting better health and self-management education. However little is known in Australia about the operationalisation of the Enhanced Primary Care (EPC) program by general medical practitioners (GPs) and private allied health (AH) providers, to manage any chronic disease. Service utilisation and patient perspectives of integrated GP/AH care under the EPC program are also largely unreported.

What does this paper add? This paper describes how the pilot program was put in place (operationalised) within the Australian context using the Medicare EPC initiative, for the management of Type II diabetes. It describes service utilisation, and patient perspectives of integrated private AH and GP care in terms of the process, and what they gained from participating in it.

What are the implications for practitioners? Integrating private AH and GP care in GPs’ rooms in Australia, under the EPC program, appears to be cost effective and readily accessible, and provides advantages for patients with Type II diabetes.