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Incentives and Disincentives in General Practice Chronic Disease Management
- 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. 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
- 3. 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
- 4. 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
- 5. 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
- 6. 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
- 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. Results: Overall issues mapped South East Queensland Research Network
- 9. Results: key themes Medicare related issues Financial viability Patient outcomes Training & support Service models: ● staff roles ● systems South East Queensland Research Network
- 10. Medical (level 2) South East Queensland Research Network
- 11. Financial viability (level 2) South East Queensland Research Network
- 12. Patient outcomes/impacts (level 2) South East Queensland Research Network
- 13. Training & support (level 2) South East Queensland Research Network
- 14. Service Models (level 2) South East Queensland Research Network
- 15. 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
- 16. 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
- 17. 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
- 18. 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
- 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. 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. Acknowledgements: Study Participants RACGP funding Griffith PHCRED funding South East Queensland Research Network South East Queensland Research Network
- 22. 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