Academic journal article Australian Health Review

Enhanced Primary Care Pilot Program Benefits Type II Diabetes Patients

Academic journal article Australian Health Review

Enhanced Primary Care Pilot Program Benefits Type II Diabetes Patients

Article excerpt

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 privateAHandGPcare 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.

Diabetes Australia anticipates that by 2010, without significant intervention to decrease individual and societal risks, 1.8 million Australians will suffer from Type II diabetes. This is a lifestyle disease related to ageing, poor exercise and nutrition choices. Its management (without complications) already places significant strain on the Australian health system, with current cost estimates of AU$1.2 billion annually.1

Chronic disease management (CDM), using primary health care multidisciplinary teams, has been recently discussed in the published and grey literature in Australia, in terms of more effective patient education, better integrated health care decisions, and effective promotion of sustainable patient selfmanagement. 2-5 Primary health care teams include general practitioners, practice nurses and nurse educators, allied health clinicians and volunteers, as appropriate to the disease. Where the team operates under one roof and is publically employed (as in community health centres and some GP Plus clinics), the model of referral and service delivery is relatively clear.6,7 However, there is little guidance regarding how to put into place a multidisciplinary primary health care chronic disease management model, where the AH practitioners work on a privately employed, sessional basis from GPs' rooms and are paid a set fee for service.

In line with the increasing body of supportive literature, multidisciplinary chronic disease management guidelines have been promoted by the Australian Government to encourage integrated primary care for patients with chronic health conditions, using the Enhanced Primary Care (EPC) program.6-10 These guidelines recommend integrating general medical practitioner (GP) and allied health (AH) care, as appropriate to the disease. The guidelines recommend active patient involvement in disease management, by providing them with education about disease self-management and healthy lifestyle behaviours. However, similar to the research evidence base, the guidelines and the EPC program provide scant detail on the actual elements of AH contribution to CDM, or the operationalisation of the EPC initiative within GP clinics using private AH providers.

Type II diabetes is one condition for which integrated GP-AH care is proposed, using credentialed diabetes educators (CDEs), dietitians and podiatrists.11,12 Dietitians provide guidance regarding dietary management, using practice guidelines promoted by the Dietetics Association of Australia.13 CDEs provide information about disease causation, management, and patients' roles in self-management and medication, using guidelines developed by the Australian Diabetes Educator Association (ADEA).14 Podiatrists provide education and practical assistance regarding foot care and foot health based on a number of clinical guidelines. …

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