Copyright © 2003 Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.BACKGROUND: The Enhanced Primary Care (EPC) program is designed to promote better management of and improved health outcomes for people with chronic illness. Specific Medicare item numbers provide government funding to encourage general practitioners to take up health assessments, care plans and case conferences. AIM: We investigated elements of the EPC program from a rural general practice perspective. METHOD: Questionnaires summarising experience of EPC for patients and health care providers, undertaken over four weeks at three rural general practices, and observation. RESULTS: The EPC program assisted the management and coordination of care for patients with multidisciplinary care needs. General practitioners were generally positive about the EPC program. The main barrier was the extra time required. The main concern of allied health workers was the lack of appropriate remuneration for their participation. Patients were positive in their responses, but many appeared to lack the motivation and self management skills to take full advantage of the program. DISCUSSION: Strategies seeking to increase the uptake of EPC items need to address efficiency and accessibility, and funding for participating health professionals.Philippa Lewis, Angela White, Gary Misan, Peter Harvey, Jerome Connolly, Joe Noon

Connolly, J.

Harvey, P.

Lewis, P.

Misan, G.

Noone, J.

White, A.

BACKGROUND: The Enhanced Primary Care (EPC) program is designed to promote better management of and improved health outcomes for people with chronic illness. Specific Medicare item numbers provide government funding to encourage general practitioners to take up health assessments, care plans and case conferences. AIM: We investigated elements of the EPC program from a rural general practice perspective. METHOD: Questionnaires summarising experience of EPC for patients and health care providers, undertaken over four weeks at three rural general practices, and observation. RESULTS: The EPC program assisted the management and coordination of care for patients with multidisciplinary care needs. General practitioners were generally positive about the EPC program. The main barrier was the extra time required. The main concern of allied health workers was the lack of appropriate remuneration for their participation. Patients were positive in their responses, but many appeared to lack the motivation and self management skills to take full advantage of the program. DISCUSSION: Strategies seeking to increase the uptake of EPC items need to address efficiency and accessibility, and funding for participating health professionals

Lewis, Philippa

White, Angela

Misan, Gary

Harvey, Peter

Connolly, Jerome

Noone, Joe

Deakin Research Online

Enhanced primary care : a rural perspective

Copyright © 2003 Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.BackgroundThe Enhanced Primary Care (EPC) program is designed to promote better management of and improved health outcomes for people with chronic illness. Specific Medicare item numbers provide government funding to encourage general practitioners to take up health assessments, care plans and case conferences.AimWe investigated elements of the EPC program from a rural general practice perspective.MethodQuestionnaires summarising experience of EPC for patients and health care providers, undertaken over four weeks at three rural general practices, and observation.ResultsThe EPC program assisted the management and coordination of care for patients with multidisciplinary care needs. General practitioners were generally positive about the EPC program. The main barrier was the extra time required. The main concern of allied health workers was the lack of appropriate remuneration for their participation. Patients were positive in their responses, but many appeared to lack the motivation and self management skills to take full advantage of the program.DiscussionStrategies seeking to increase the uptake of EPC items need to address efficiency and accessibility, and funding for participating health professionals.Philippa Lewis, Angela White, Gary Misan, Peter Harvey, Jerome Connolly, Joe Noon

Adelaide Research &amp; Scholarship

The Enhanced Primary Care (EPC)program, announced in the May 1999Federal Budget, consists of a range ofinnovations designed to encourage healthcare providers to better assist and care forpeople with chronic illnesses and complexcare needs. It emerged from the earlyoutcomes of coordinated care trials1–3 witha focus on preventive and multidiscipli-nary care, and encourages patients tohave a more active role in their manage-ment. It also consists of Medicare rebatesfor annual health assessments for theaged, and for general practitionerinvolvement in care planning and caseconferencing. It is based on a preventivecare model.4–7AimsWe investigated some aspects of the EPCprogram from a rural health vantage point.EPC item numbersAged Health Assessments can be pro-vided for any patient over the age of 75years, or any Aboriginal or Torres StraitIslander patient over the age of 55 years. Care Plans may be prepared for anypatient with a chronic and complexmedical condition and who requires mul-tidisciplinary care from at least two otherhealth care providers. Case Conferences may be provided forany patient who has a chronic medicalcondition and who requires multidiscipli-nary care from at least two other healthcare providers. In contrast to care plans,the patient and health care team meettogether to discuss key health care issuesand to develop care management goals.  The Practice Incentives Program The Practice Incentives Program (PIP) ispart of a payment system for GPs. It isdesigned to promote the aspects ofEnhanced Primary Care A rural perspectivePhilippa Lewis, Angela White, Gary Misan, Peter Harvey, Jerome Connolly, Joe NoonePhilippa Lewis, is a fifth year medical student, Adelaide University, South Australia. Angela White, is a fifth year medical student, Adelaide University, South Australia. Gary Misan, PhD, BPharm, is Associate Professor and Head, South Australian Centre for Rural and Remote Health, Whyalla, South Australia.Peter Harvey, PhD, BEd, is Manager, Sharing Health Care SA Project, Spencer Gulf Rural Health School, South AustralianCentre for Rural and Remote Health, Whyalla, South Australia.Jerome Connolly, MBCHB, is a general practitioner, Whyalla Clinic, South Australia. Joe Noone, BHS (Hon), is a research associate, South Australian Centre for Rural and Remote Health, Whyalla, South Australia.BACKGROUND The Enhanced Primary Care (EPC) program is designed to promote better management of and improvedhealth outcomes for people with chronic illness. Specific Medicare item numbers provide government funding toencourage general practitioners to take up health assessments, care plans and case conferences. AIM We investigated elements of the EPC program from a rural general practice perspective.METHOD Questionnaires summarising experience of EPC for patients and health care providers, undertaken over fourweeks at three rural general practices, and observation. RESULTS The EPC program assisted the management and coordination of care for patients with multidisciplinary careneeds. General practitioners were generally positive about the EPC program. The main barrier was the extra timerequired. The main concern of allied health workers was the lack of appropriate remuneration for their participation.Patients were positive in their responses, but many appeared to lack the motivation and self management skills to takefull advantage of the program. DISCUSSION Strategies seeking to increase the uptake of EPC items need to address efficiency and accessibility, andfunding for participating health professionals.2 • Reprinted from Australian Family Physician Vol. 32, No. 3, March 2003general practice that are associated withquality health care, such as the provisionof after hours services and student teach-ing, by compensating GPs who take timeto look after the continuing health careneeds of their patients rather than relyingon many quick consultations for incomealone. A ‘rural loading’ is paid to prac-tices in rural and remote locations. PIP payments support the uptake ofcase conferencing and care planning inaddition to the individual MedicalBenefits Schedule (MBS) item numbers.Payment is made to medical practices thatmeet a specified coverage rate based onthe number of patients aged over 65 yearsas a rough estimate of the numbers ofpatients with complex care needs attend-ing the practice. MethodsWe collected data over four weeks in twogeneral practices in Whyalla and one inPort Lincoln, South Australia; designatedpractices A, B and C throughout the follow-ing report. We:• talked to relevant health professionals,• examined relevant documents• observed EPC consultations in differentrural general practices, and • administered questionnaires to patientsand health care providers using a 5-pointscale.ResultsRecruitment and recall of patientsWe observed two methods for GPsrecruiting patients for EPC:• searching their patient records elec-tronically to identify eligible people,and • opportunistically with patients attend-ing routinely. Health assessmentsTwo health assessments were observed attwo practices. The practice nurse col-lected most of the information.Assessment of patients’ clinical condi-tions and medications was more thoroughthan psychological and social function.In the third practice, health assess-ments were completed at home whichallowed for a direct assessment, especiallyof factors predisposing to falls.Care plansWe observed 16 care plans. The assess-ments of patients’ problems and careneeds were comprehensive with clearmanagement plans. Involvement of otherhealth care providers varied fromminimal to active contribution to theplan’s development. So also was thedegree to which patients defined programaims, which varied in the extent to whichthey were clearly set out, the input of thehealth care providers, and the emphasison medical or lifestyle issues.Patient and health care providerquestionnaires Patients reported better matching ofhealth care services to need, improvedquality of health care and improvementsin their own knowledge of their conditionand its management following introduc-tion of the EPC program. Whether theEPC had improved their relationshipswith their doctor and other health careproviders was unclear.Some suggested improvements werehome care plans or health assessments con-ducted for those with mobility difficulties.Health care providers surveyed wereinvolved with the EPC program. Theseincluded four GPs, three practice nurses,a diabetes nurse, diabetic educators, aservice coordinator, a dietician and a podiatrist.The GPs were generally positive aboutthe EPC program: integration of healthcare services had improved, although ITsupport needed further development.Allied health practitioner responseswere more variable. Although most werepositive about the EPC program, it wasnot clear that it had constructive impacton their practice.Perhaps there was better communica-tion between medical and nonmedicalworkers. However, some commented onthe lack of funding to allied healthworkers, and perceived doctors overdominated decisions in care plans.DiscussionThese findings should be interpreted cau-tiously; the samples were notrepresentative, and were small. Generalpractitioners and allied health practition-ers who participated were probably biasedtoward being positive about the program.Similarly, the responding patients wereskewed toward those with long term andcontinuing involvement with the program,and not those who had dropped out. These initial findings suggest a subjec-tive improvement from the use of the EPCprogram on the health care coordinationof the elderly and those with chronic con-ditions. Possible improvements to theprocess may include encouraging GPs toset aside one or more designated sessions aweek for EPC activities, developing moreeffective information technology supportsystems for documenting and accessingpatient records, and the provision of ade-quate remuneration for all healthproviders involved.Conflict of interest: none declared.References1. Podger A. Reforming the Australian healthcare system: a government perspective.Health Aff 1999; 18:111–113.2. Commonwealth of Australia. TheAustralian Coordinated Care Trials: Interimnational evaluation – summary. Canberra:Commonwealth Department of Health andAged Care, 1999.3. Harvey P W. PhD thesis: Coordinated careand change leadership: inside the changeprocess [PhD]. Perth: University ofWestern Australia, 2001.4. Telford R D, Reid R A, Vickery D M, Fries JF. Optimising health status and cost out-comes through population healthimprovement. Brisbane: HealthtracAustralia, 2000.Reprinted from Australian Family Physician Vol. 32, No. 3, March 2003 • 35. Lorig K, Stewart A, Ritter P, Gonzales V,Laurent D, Lynch J. Outcome measures forhealth education and other health careinterventions. California: SAGEPublications Inc, 1996.6. Fries J, Koop C, Beadle C, et al. Reducinghealth care costs by reducing the need anddemand for medical services. N Engl J Med1993; 329(5):321–325.7. Fries J F, Koop C, Sokolov J, E B C, WrightD. Beyond health promotion: reducingneed and demand for medical care. HealthAff 1998; 17:70–84.8. Eyre Peninsula Division of GeneralPractice, Pfizer. Eyre Care. In:http:/www.eyrecare.com; 20029. Scott C. Public and private roles in healthcare systems. Philadelphia: OpenUniversity Press, 2001.10. Royal Australian College of GeneralPractitioners. Chronic condition self man-agement guidelines for GPs. In:http:/www.racgp.org.au/folder.asp?id=229;200211. Battersby M, et al. The partners in healthhandbook: a guide to help you become anactive partner in the management of yourhealth. Adelaide: Flinders University ofSouth Australia Coordinated Care TrainingUnit, 2000; 25.CorrespondenceDr Peter HarveyEmail: peter.harvey@unisa.edu.auAFP4 • Reprinted from Australian Family Physician Vol. 32, No. 3, March 2003

Enhanced Primary Care - A rural perspective

Harvey, Peter William

Noone, Joe T

Flinders Academic Commons

Archived at the Flinders Academic Commons:  http://dspace.flinders.edu.au/dspace/  This is the publisher’s copyrighted version of this article.  The original can be found at: http://www.racgp.org.au/afp/200303/20030301lewis.pdf © 2003 Australian Family Physician www.afp.org.au Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners. The Enhanced Primary Care (EPC)program, announced in the May 1999Federal Budget, consists of a range ofinnovations designed to encourage healthcare providers to better assist and care forpeople with chronic illnesses and complexcare needs. It emerged from the earlyoutcomes of coordinated care trials1–3 witha focus on preventive and multidiscipli-nary care, and encourages patients tohave a more active role in their manage-ment. It also consists of Medicare rebatesfor annual health assessments for theaged, and for general practitionerinvolvement in care planning and caseconferencing. It is based on a preventivecare model.4–7AimsWe investigated some aspects of the EPCprogram from a rural health vantage point.EPC item numbersAged Health Assessments can be pro-vided for any patient over the age of 75years, or any Aboriginal or Torres StraitIslander patient over the age of 55 years. Care Plans may be prepared for anypatient with a chronic and complexmedical condition and who requires mul-tidisciplinary care from at least two otherhealth care providers. Case Conferences may be provided forany patient who has a chronic medicalcondition and who requires multidiscipli-nary care from at least two other healthcare providers. In contrast to care plans,the patient and health care team meettogether to discuss key health care issuesand to develop care management goals.  The Practice Incentives Program The Practice Incentives Program (PIP) ispart of a payment system for GPs. It isdesigned to promote the aspects ofEnhanced Primary Care A rural perspectivePhilippa Lewis, Angela White, Gary Misan, Peter Harvey, Jerome Connolly, Joe NoonePhilippa Lewis, is a fifth year medical student, Adelaide University, South Australia. Angela White, is a fifth year medical student, Adelaide University, South Australia. Gary Misan, PhD, BPharm, is Associate Professor and Head, South Australian Centre for Rural and Remote Health, Whyalla, South Australia.Peter Harvey, PhD, BEd, is Manager, Sharing Health Care SA Project, Spencer Gulf Rural Health School, South AustralianCentre for Rural and Remote Health, Whyalla, South Australia.Jerome Connolly, MBCHB, is a general practitioner, Whyalla Clinic, South Australia. Joe Noone, BHS (Hon), is a research associate, South Australian Centre for Rural and Remote Health, Whyalla, South Australia.BACKGROUND The Enhanced Primary Care (EPC) program is designed to promote better management of and improvedhealth outcomes for people with chronic illness. Specific Medicare item numbers provide government funding toencourage general practitioners to take up health assessments, care plans and case conferences. AIM We investigated elements of the EPC program from a rural general practice perspective.METHOD Questionnaires summarising experience of EPC for patients and health care providers, undertaken over fourweeks at three rural general practices, and observation. RESULTS The EPC program assisted the management and coordination of care for patients with multidisciplinary careneeds. General practitioners were generally positive about the EPC program. The main barrier was the extra timerequired. The main concern of allied health workers was the lack of appropriate remuneration for their participation.Patients were positive in their responses, but many appeared to lack the motivation and self management skills to takefull advantage of the program. DISCUSSION Strategies seeking to increase the uptake of EPC items need to address efficiency and accessibility, andfunding for participating health professionals.2 • Reprinted from Australian Family Physician Vol. 32, No. 3, March 2003general practice that are associated withquality health care, such as the provisionof after hours services and student teach-ing, by compensating GPs who take timeto look after the continuing health careneeds of their patients rather than relyingon many quick consultations for incomealone. A ‘rural loading’ is paid to prac-tices in rural and remote locations. PIP payments support the uptake ofcase conferencing and care planning inaddition to the individual MedicalBenefits Schedule (MBS) item numbers.Payment is made to medical practices thatmeet a specified coverage rate based onthe number of patients aged over 65 yearsas a rough estimate of the numbers ofpatients with complex care needs attend-ing the practice. MethodsWe collected data over four weeks in twogeneral practices in Whyalla and one inPort Lincoln, South Australia; designatedpractices A, B and C throughout the follow-ing report. We:• talked to relevant health professionals,• examined relevant documents• observed EPC consultations in differentrural general practices, and • administered questionnaires to patientsand health care providers using a 5-pointscale.ResultsRecruitment and recall of patientsWe observed two methods for GPsrecruiting patients for EPC:• searching their patient records elec-tronically to identify eligible people,and • opportunistically with patients attend-ing routinely. Health assessmentsTwo health assessments were observed attwo practices. The practice nurse col-lected most of the information.Assessment of patients’ clinical condi-tions and medications was more thoroughthan psychological and social function.In the third practice, health assess-ments were completed at home whichallowed for a direct assessment, especiallyof factors predisposing to falls.Care plansWe observed 16 care plans. The assess-ments of patients’ problems and careneeds were comprehensive with clearmanagement plans. Involvement of otherhealth care providers varied fromminimal to active contribution to theplan’s development. So also was thedegree to which patients defined programaims, which varied in the extent to whichthey were clearly set out, the input of thehealth care providers, and the emphasison medical or lifestyle issues.Patient and health care providerquestionnaires Patients reported better matching ofhealth care services to need, improvedquality of health care and improvementsin their own knowledge of their conditionand its management following introduc-tion of the EPC program. Whether theEPC had improved their relationshipswith their doctor and other health careproviders was unclear.Some suggested improvements werehome care plans or health assessments con-ducted for those with mobility difficulties.Health care providers surveyed wereinvolved with the EPC program. Theseincluded four GPs, three practice nurses,a diabetes nurse, diabetic educators, aservice coordinator, a dietician and a podiatrist.The GPs were generally positive aboutthe EPC program: integration of healthcare services had improved, although ITsupport needed further development.Allied health practitioner responseswere more variable. Although most werepositive about the EPC program, it wasnot clear that it had constructive impacton their practice.Perhaps there was better communica-tion between medical and nonmedicalworkers. However, some commented onthe lack of funding to allied healthworkers, and perceived doctors overdominated decisions in care plans.DiscussionThese findings should be interpreted cau-tiously; the samples were notrepresentative, and were small. Generalpractitioners and allied health practition-ers who participated were probably biasedtoward being positive about the program.Similarly, the responding patients wereskewed toward those with long term andcontinuing involvement with the program,and not those who had dropped out. These initial findings suggest a subjec-tive improvement from the use of the EPCprogram on the health care coordinationof the elderly and those with chronic con-ditions. Possible improvements to theprocess may include encouraging GPs toset aside one or more designated sessions aweek for EPC activities, developing moreeffective information technology supportsystems for documenting and accessingpatient records, and the provision of ade-quate remuneration for all healthproviders involved.Conflict of interest: none declared.References1. Podger A. Reforming the Australian healthcare system: a government perspective.Health Aff 1999; 18:111–113.2. Commonwealth of Australia. TheAustralian Coordinated Care Trials: Interimnational evaluation – summary. Canberra:Commonwealth Department of Health andAged Care, 1999.3. Harvey P W. PhD thesis: Coordinated careand change leadership: inside the changeprocess [PhD]. Perth: University ofWestern Australia, 2001.4. Telford R D, Reid R A, Vickery D M, Fries JF. Optimising health status and cost out-comes through population healthimprovement. Brisbane: HealthtracAustralia, 2000.Reprinted from Australian Family Physician Vol. 32, No. 3, March 2003 • 35. Lorig K, Stewart A, Ritter P, Gonzales V,Laurent D, Lynch J. Outcome measures forhealth education and other health careinterventions. California: SAGEPublications Inc, 1996.6. Fries J, Koop C, Beadle C, et al. Reducinghealth care costs by reducing the need anddemand for medical services. N Engl J Med1993; 329(5):321–325.7. Fries J F, Koop C, Sokolov J, E B C, WrightD. Beyond health promotion: reducingneed and demand for medical care. HealthAff 1998; 17:70–84.8. Eyre Peninsula Division of GeneralPractice, Pfizer. Eyre Care. In:http:/www.eyrecare.com; 20029. Scott C. Public and private roles in healthcare systems. Philadelphia: OpenUniversity Press, 2001.10. Royal Australian College of GeneralPractitioners. Chronic condition self man-agement guidelines for GPs. In:http:/www.racgp.org.au/folder.asp?id=229;200211. Battersby M, et al. The partners in healthhandbook: a guide to help you become anactive partner in the management of yourhealth. Adelaide: Flinders University ofSouth Australia Coordinated Care TrainingUnit, 2000; 25.CorrespondenceDr Peter HarveyEmail: peter.harvey@unisa.edu.auAFP4 • Reprinted from Australian Family Physician Vol. 32, No. 3, March 2003

Enhanced Primary Care: A rural
            perspective

https://digital.library.adelaide.edu.au/dspace/bitstream/2440/42196/1/hdl_42196.pdf

Enhanced Primary Care - A rural perspective

Abstract

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Deakin Research Online

Adelaide Research & Scholarship

Flinders Academic Commons

Enhanced Primary Care - A rural perspective

Abstract

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Full text

Available Versions

Deakin Research Online

Adelaide Research &amp; Scholarship

Flinders Academic Commons

Adelaide Research & Scholarship