Academic journal article Australian Health Review

Effects of the Medicare Enhanced Primary Care Program on Primary Care Physician Contact in the Population of Older Western Australians with Chronic Diseases

Academic journal article Australian Health Review

Effects of the Medicare Enhanced Primary Care Program on Primary Care Physician Contact in the Population of Older Western Australians with Chronic Diseases

Article excerpt

(ProQuest: ... denotes formulae omitted.)

Introduction

Current Australian Bureau of Statistics (ABS) projections indicate by the year 2056, 23-25% of Australia's population will be aged over 65 years, in comparison to 13% in 2007,1 thereby increasing demand on the health system.2,3 In Australia, nearly two-thirds of avoidable hospitalisations for ambulatory care sensitive conditions (ACSCs) are due to chronic illness.4-7 Thus the more effective provision of primary care is central to Australia's national strategy for chronic disease control both now and into the future.

To reduce the burden of avoidable hospitalisations from chronic diseases the enhanced primary care (EPC) program was introduced in November 1999 as a set of claim items registered in Australia's Medicare Benefits Schedule (MBS).2 The objectives of these government-supported services were to improve the regularity and quality of healthcare provided by general practitioners (GPs) to older Australians and those with chronic diseases. 2,8 In particular, the EPC items included annual health assessments for people aged >75 years (>55 years for Indigenous Australians) to assess whether preventive or educational services should be offered to the patient.9 Additionally, EPC multidisciplinary care plans and case conferences became available for patients of any age with chronic or terminal conditions.10

After their introduction, EPC services were promoted to Australian GPs with increasing intensity as a means to improve chronic disease outcomes.11 The cost of EPC items in 2007-08 of 2.064 million items nationally was $203.8 million.12 Despite its high cost, the evaluation of EPC services has been limited to measurements of GP awareness and acceptance,2,13,14 uptake by patients across population subgroups14 and program fidelity.15 No evaluation has occurred to date in terms of population-level uptake, effect on regularity as distinct from frequency ofGPvisits and the effects on disease progression and hospitalisations in patients with chronic diseases.12

The aim of this study was to assess the use of EPC services in the Western Australian population and to evaluate the effects of EPCservices on the regularity ofGPvisits in patients with chronic diseases.

Methods

Data sources and study population

The study population was defined as individuals aged 65+ years who had been registered continuously in WA by Medicare since its inception in 1984.16 For these individuals de-identified records were extracted and linked at the individual level for: (i) MBS records originating in WA from 2001 to 2006; (ii) WA hospital morbidity data system (HMDS) records from 1999 to 2006; (iii) WA mortality records from 2001 to 2006; and (iv) WA Electoral Roll records from 2001 to 2006.

Identification of EPC items and GP consultation records

MBS records not relating to EPC or other GP claims were removed from the dataset. EPC or other GP claim records were identified using the MBS item numbers taken from published schedules relevant to each year of study. EPC items were defined as any service listed under Groups A14 and A15 of the relevant MBSschedule.17 GP claims were defined as any item listed in the explanatory notes of the relevant MBS as 'Attendances by General Practitioners'.17

Determination of recent chronic disease history

Hospitalisation within the previous 2 years for seven ACSCs - type 2 diabetes, asthma and chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), seizures, dyspepsia, hypertension and heart failure18 - was assessed using the primary and secondary diagnosisfields ofHMDSrecords for each individual. A set of International Classification of Diseases 10th Revision (ICD-10) codes for each disease was devised and independently validated by a clinical consensus panel comprising nine GPs, two medical specialists and two clinical pharmacists.

Calculation of primary medical care regularity

For each patient in each year, theMBSdata were used to calculate the number of days from the start of the year to the first primary care visit (whether EPC or other GP service); between each subsequent pair of primary care visits during the year; and from the last primary care visit to the end of the year. …

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