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Incentives and Disincentives in General Practice Chronic Disease Management
 

Incentives and Disincentives in General Practice Chronic Disease Management

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    Incentives and Disincentives in General Practice Chronic Disease Management Incentives and Disincentives in General Practice Chronic Disease Management Presentation Transcript

    • Incentives & Disincentives in General Practice Chronic Disease Management Dr. Ian Williams 1 Libby Holden2, Lily Cheung2, Prof Liz Patterson2, Dr Jane Smith3, Xanthe Golenko2,, Robyn Chambers 1 1: Camp Hill Medical Centre, 2: Griffith University, 3: Mudgeeraba Medical Centre South East Queensland Research Network
    • Aims & Rationale
      • Aims:
        • To explore the impacts of chronic disease management (CDM) incentives on general practice service providers
        • To identify opportunities of improvements to CDM care management and optimal use of CDM incentives
      • Rationale:
        • Chronic disease responsible for 80% of total of burden of disease (1)
        • Only 50% of Australian CDM patients are receiving optimal care (2)
        • Chronic disease patients have complex needs (2)
        • Medicare CDM items are intended to provide incentives to GPs (3)
        • Problems with some Medicare items flagged by GPs in SEQRN
      South East Queensland Research Network
    • Methods – study design
      • Exploratory, qualitative research design
        • Phase 1 – discipline specific focus groups
        • Phase 2 – in-depth interviews with staff from nine practices
        • Phase 3 – extrapolation of findings and collaboratively develop recommendation
      South East Queensland Research Network
    • Methods: Sampling frame
      • Mix of:
        • high, med, low incentives use
        • Solo, 2-5, 6+ GPs
        • non, part, full computerized
        • Urban, outer metro, rural
      South East Queensland Research Network
    • Methods: study participants
        • Phase 1: range of individuals from eight different practices – discipline specific focus groups
        • Phase 2: practice principal/or GP, Practice Manager & Practice Nurse from nine practices (only 4 same as practices from phase 1)
        • Phase 3: yet to occur, plan to consult with all who participated in either phase 1 or 2
      South East Queensland Research Network
    • Results: Study sample for phase 2
        • Nine practices
        • 6 Practice GP Principals, 3 GPs
        • 7 Registered Nurses, 2 Enrolled Nurse
        • 9 Practice Managers
      South East Queensland Research Network
    • Results: Study Sample (cont) South East Queensland Research Network age sex Yrs in GP Yrs in this practice Qualifications Practice Principal /GP All >45 yr except 1 @ 35-44 5 males 4 females All >10 yr except 1 3: <5yrs 4: 6-20yr 2: >20yrs 5 FRACGP All MBBS Practice Nurse 1: <35yr 2: 35-44yr 3: 45-54yr 2: >55yr 9 females All <10 yr except 2 All < 5 yrs except 2 6: RN 2: EN 1 unrecorded Practice Manager 4: 35-44yr 3: 45-54yr 2: > 55yr 9 females 1: <10yr 6: 10-20yr 2: >20yr 6: < 10yr 3: 10-20yr 3: nil 1: EN,1:RN 1 Cert, 1: Dip, 1: BComm 1:FAAPM
    • Results: Overall issues mapped South East Queensland Research Network
    • Results: key themes
        • Medicare related issues
        • Financial viability
        • Patient outcomes
        • Training & support
        • Service models:
      • ● staff roles
      • ● systems
      South East Queensland Research Network
    • Medical (level 2) South East Queensland Research Network
    • Financial viability (level 2) South East Queensland Research Network
    • Patient outcomes/impacts (level 2) South East Queensland Research Network
    • Training & support (level 2) South East Queensland Research Network
    • Service Models (level 2) South East Queensland Research Network
    • Discussion: key messages
        • Variation in practice structures, role delineation, software systems, and referral networks
        • No apparent link between practice structure & CDM income
        • Fine balance between patient care and practice viability
        • Conflicting views on financial viability
      South East Queensland Research Network
    • Discussion: key messages (cont)
        • Improved patient outcomes reported by practice staff:
      • ↟ patient care monitoring
      • ↡ acute care episodes
      • ↟ quality of care
      • ↟ patient engagement in & expectations of care
      South East Queensland Research Network
    • Discussion: key messages (cont)
        • Medicare disincentives:
      • ◊ inconsistent &/or poor access to information on patient eligibility
      • ◊ Need for improved systems at Medicare level before rolling out new items
      • ◊ Need for consistent & transparent requirements from Medicare
        • Value of NPCC involvements for developing standardised systems at practice level
      South East Queensland Research Network
    • Discussion: key messages (cont)
        • Variable barriers & enablers for nurses
          • Barrier - need for infrastructure (e.g. confidential room) for RN role, time pressures, changing expectations e.g. bring in $ to cover wages
          • Enabler – ↟ satisfaction from ↟ patient interaction & ability to work positively re patient care, improved team approach & rapport building with GP
      South East Queensland Research Network
    • Implications & Recommendations: Medicare to consider: ◊ the value of CDM MBS items based on nursing care only e.g. education, preventative health care & monitoring role e.g. hypertension ◊ that systems & training is required before implement new Medicare items South East Queensland Research Network
    • Implications & Recommendations: Public / policy level debate on: The funding of general practice based on quality of care outcomes rather than episodic care South East Queensland Research Network
    • Acknowledgements:
        • Study Participants
        • RACGP funding
        • Griffith PHCRED funding
        • South East Queensland Research Network
      South East Queensland Research Network
    • References
        • National Health Priority Action Council, National Chronic disease Strategy , Australian Government Department of Health and Ageing, Editor. 2006, Australian Health Ministers' conference 2005.
        • Infante, F.A., et al., How people with chronic illnesses view their care in general practice: a qualitative study. Medical Journal of Australia, 2004. 181(2): p. 70-73.
        • Department of Health and Aging, Chronic Disease Management (CDM) Medicare Items: Q & As Updated with November 2006 MBS fees
      South East Queensland Research Network