Incentives & Disincentives  in General Practice  Chronic Disease Management Dr. Ian Williams 1 Libby Holden2, Lily Cheung2...
Aims & Rationale <ul><li>Aims: </li></ul><ul><ul><li>To explore the impacts of chronic disease management (CDM) incentives...
Methods – study design <ul><li>Exploratory, qualitative research design </li></ul><ul><ul><li>Phase 1 – discipline specifi...
Methods: Sampling frame <ul><li>Mix of: </li></ul><ul><ul><li>high, med, low incentives use </li></ul></ul><ul><ul><li>Sol...
Methods: study participants <ul><ul><li>Phase 1: range of individuals from eight different practices –  discipline specifi...
Results:  Study sample for phase 2 <ul><ul><li>Nine practices  </li></ul></ul><ul><ul><li>6 Practice GP Principals, 3 GPs ...
Results: Study Sample (cont) South East Queensland Research Network age sex Yrs in GP Yrs in this practice Qualifications ...
Results: Overall issues mapped South East Queensland Research Network
Results: key themes <ul><ul><li>Medicare related issues </li></ul></ul><ul><ul><li>Financial viability </li></ul></ul><ul>...
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 <ul><ul><li>Variation in practice structures, role delineation, software systems, and referral ne...
Discussion: key messages (cont) <ul><ul><li>Improved patient outcomes reported by practice staff: </li></ul></ul><ul><li>↟...
Discussion: key messages  (cont) <ul><ul><li>Medicare disincentives: </li></ul></ul><ul><li>◊  inconsistent &/or poor acce...
Discussion: key messages (cont) <ul><ul><li>Variable barriers & enablers for nurses   </li></ul></ul><ul><ul><ul><li>Barri...
Implications & Recommendations:  Medicare to consider:  ◊  the value of CDM MBS items based on nursing care only e.g. educ...
Implications & Recommendations: Public / policy level debate on: The funding of general practice  based on quality of care...
Acknowledgements: <ul><ul><li>Study Participants  </li></ul></ul><ul><ul><li>RACGP funding </li></ul></ul><ul><ul><li>Grif...
References <ul><ul><li>National Health Priority Action Council,  National Chronic disease Strategy , Australian Government...
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Incentives and Disincentives in General Practice Chronic Disease Management

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Incentives and Disincentives in General Practice Chronic Disease Management

  1. 1. 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
  2. 2. Aims & Rationale <ul><li>Aims: </li></ul><ul><ul><li>To explore the impacts of chronic disease management (CDM) incentives on general practice service providers </li></ul></ul><ul><ul><li>To identify opportunities of improvements to CDM care management and optimal use of CDM incentives </li></ul></ul><ul><li>Rationale: </li></ul><ul><ul><li>Chronic disease responsible for 80% of total of burden of disease (1) </li></ul></ul><ul><ul><li>Only 50% of Australian CDM patients are receiving optimal care (2) </li></ul></ul><ul><ul><li>Chronic disease patients have complex needs (2) </li></ul></ul><ul><ul><li>Medicare CDM items are intended to provide incentives to GPs (3) </li></ul></ul><ul><ul><li>Problems with some Medicare items flagged by GPs in SEQRN </li></ul></ul>South East Queensland Research Network
  3. 3. Methods – study design <ul><li>Exploratory, qualitative research design </li></ul><ul><ul><li>Phase 1 – discipline specific focus groups </li></ul></ul><ul><ul><li>Phase 2 – in-depth interviews with staff from nine practices </li></ul></ul><ul><ul><li>Phase 3 – extrapolation of findings and collaboratively develop recommendation </li></ul></ul>South East Queensland Research Network
  4. 4. Methods: Sampling frame <ul><li>Mix of: </li></ul><ul><ul><li>high, med, low incentives use </li></ul></ul><ul><ul><li>Solo, 2-5, 6+ GPs </li></ul></ul><ul><ul><li>non, part, full computerized </li></ul></ul><ul><ul><li>Urban, outer metro, rural </li></ul></ul>South East Queensland Research Network
  5. 5. Methods: study participants <ul><ul><li>Phase 1: range of individuals from eight different practices – discipline specific focus groups </li></ul></ul><ul><ul><li>Phase 2: practice principal/or GP, Practice Manager & Practice Nurse from nine practices (only 4 same as practices from phase 1) </li></ul></ul><ul><ul><li>Phase 3: yet to occur, plan to consult with all who participated in either phase 1 or 2 </li></ul></ul>South East Queensland Research Network
  6. 6. Results: Study sample for phase 2 <ul><ul><li>Nine practices </li></ul></ul><ul><ul><li>6 Practice GP Principals, 3 GPs </li></ul></ul><ul><ul><li>7 Registered Nurses, 2 Enrolled Nurse </li></ul></ul><ul><ul><li>9 Practice Managers </li></ul></ul>South East Queensland Research Network
  7. 7. 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
  8. 8. Results: Overall issues mapped South East Queensland Research Network
  9. 9. Results: key themes <ul><ul><li>Medicare related issues </li></ul></ul><ul><ul><li>Financial viability </li></ul></ul><ul><ul><li>Patient outcomes </li></ul></ul><ul><ul><li>Training & support </li></ul></ul><ul><ul><li>Service models: </li></ul></ul><ul><li>● staff roles </li></ul><ul><li>● systems </li></ul>South East Queensland Research Network
  10. 10. Medical (level 2) South East Queensland Research Network
  11. 11. Financial viability (level 2) South East Queensland Research Network
  12. 12. Patient outcomes/impacts (level 2) South East Queensland Research Network
  13. 13. Training & support (level 2) South East Queensland Research Network
  14. 14. Service Models (level 2) South East Queensland Research Network
  15. 15. Discussion: key messages <ul><ul><li>Variation in practice structures, role delineation, software systems, and referral networks </li></ul></ul><ul><ul><li>No apparent link between practice structure & CDM income </li></ul></ul><ul><ul><li>Fine balance between patient care and practice viability </li></ul></ul><ul><ul><li>Conflicting views on financial viability </li></ul></ul>South East Queensland Research Network
  16. 16. Discussion: key messages (cont) <ul><ul><li>Improved patient outcomes reported by practice staff: </li></ul></ul><ul><li>↟ patient care monitoring </li></ul><ul><li>↡ acute care episodes </li></ul><ul><li>↟ quality of care </li></ul><ul><li>↟ patient engagement in & expectations of care </li></ul>South East Queensland Research Network
  17. 17. Discussion: key messages (cont) <ul><ul><li>Medicare disincentives: </li></ul></ul><ul><li>◊ inconsistent &/or poor access to information on patient eligibility </li></ul><ul><li>◊ Need for improved systems at Medicare level before rolling out new items </li></ul><ul><li>◊ Need for consistent & transparent requirements from Medicare </li></ul><ul><ul><li>Value of NPCC involvements for developing standardised systems at practice level </li></ul></ul>South East Queensland Research Network
  18. 18. Discussion: key messages (cont) <ul><ul><li>Variable barriers & enablers for nurses </li></ul></ul><ul><ul><ul><li>Barrier - need for infrastructure (e.g. confidential room) for RN role, time pressures, changing expectations e.g. bring in $ to cover wages </li></ul></ul></ul><ul><ul><ul><li>Enabler – ↟ satisfaction from ↟ patient interaction & ability to work positively re patient care, improved team approach & rapport building with GP </li></ul></ul></ul>South East Queensland Research Network
  19. 19. 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
  20. 20. 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
  21. 21. Acknowledgements: <ul><ul><li>Study Participants </li></ul></ul><ul><ul><li>RACGP funding </li></ul></ul><ul><ul><li>Griffith PHCRED funding </li></ul></ul><ul><ul><li>South East Queensland Research Network </li></ul></ul>South East Queensland Research Network
  22. 22. References <ul><ul><li>National Health Priority Action Council, National Chronic disease Strategy , Australian Government Department of Health and Ageing, Editor. 2006, Australian Health Ministers' conference 2005. </li></ul></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>Department of Health and Aging, Chronic Disease Management (CDM) Medicare Items: Q & As Updated with November 2006 MBS fees </li></ul></ul>South East Queensland Research Network

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