Grimmer-Somers Karen, Dolesj Wendy, Atkinson Joanne
Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia.
Aust Health Rev. 2010 Mar;34(1):18-24. doi: 10.1071/AH09619.
The Australian Government Medicare Enhanced Primary Care (EPC) initiative for chronic disease management (CDM) supports integrated allied health (AH) and general medical practitioner (GP) care. There are limited examples of how to operationalise this initiative in private practice, and minimal evidence of expected service utilisation or acceptability to patients. This paper reports on a 2007 Australian integrated GP/private sector AH pilot program, based on Medicare EPC guidelines for Type II diabetes.
Describe how the pilot program was put in place (operationalised). Report on service utilisation and patient perspectives of the pilot program.
Pilot program: patients with Type II diabetes were referred to credentialed diabetes educators (CDEs), dietitians or podiatrists by their GP, via a Medicare-approved team care arrangement (TCA). Dietitians and CDEs operated on a sessional basis from GPs' rooms, and podiatrists operated from their own clinics. All AH providers accepted the Medicare Plus rebate only, and provided guidelines-based care (focussed on patient education, disease ownership and self-management). Service utilisation was measured by the number and type of AH attendances per patient. Patient perspectives of the pilot program, and what they perceived they had gained from participation in it, were measured by semi-structured telephone interviews.
An average of 2.3 AH consultations were consumed by 588 patients, of whom 59 were interviewed. Interviewed patients appreciated the ready and timely access to AH services at no additional cost, the integration of GP/AH care, and being actively involved in managing their disease. Approximately 60% of patients had never previously consulted an AH provider regarding diabetes. Interviewees perceived that collocated, integrated GP-AH care heightened their disease awareness, improved their knowledge of their disease and encouraged them to better self-manage. Most interviewees indicated that they did not require further AH assistance in the short term (having gained what assistance they needed), and approximately 60% interviewees indicated they would pay a gap fee for similar AH services in the future.
Integrated AH/GP guidelines-based care provided in GP clinics appears to be cost efficient. It has the potential to improve patient access to AH care, promote the role of integrated care in the management of Type II diabetes, and improve patient education and self-management.
澳大利亚政府医疗保险强化初级保健（EPC）慢性病管理（CDM）倡议支持联合健康（AH）和全科医生（GP）的综合护理。关于如何在私人诊所实施该倡议的示例有限，关于预期服务利用率或患者接受度的证据也很少。本文报告了一项基于医疗保险EPC II型糖尿病指南的2007年澳大利亚全科医生/私营部门联合健康试点项目。
描述试点项目是如何实施的。报告试点项目的服务利用率和患者观点。
试点项目：II型糖尿病患者由其全科医生通过医疗保险批准的团队护理安排（TCA）转介给有资质的糖尿病教育者（CDE）、营养师或足病医生。营养师和CDE在全科医生的诊室按场次工作，足病医生在自己的诊所工作。所有联合健康提供者仅接受医疗保险加计回扣，并提供基于指南的护理（侧重于患者教育、疾病认知和自我管理）。服务利用率通过每位患者的联合健康就诊次数和类型来衡量。通过半结构化电话访谈来衡量患者对试点项目的看法以及他们认为从参与项目中获得了什么。
588名患者平均进行了2.3次联合健康咨询，其中59人接受了访谈。接受访谈的患者赞赏能够免费即时且及时地获得联合健康服务、全科医生/联合健康护理的整合以及积极参与疾病管理。大约60%的患者此前从未就糖尿病咨询过联合健康提供者。受访者认为并置的、整合的全科医生 - 联合健康护理提高了他们的疾病意识，改善了他们对疾病的了解，并鼓励他们更好地自我管理。大多数受访者表示短期内他们不需要进一步的联合健康援助（已经获得了所需的帮助），大约60%的受访者表示他们未来会为类似的联合健康服务支付差价费用。
在全科医生诊所提供的基于联合健康/全科医生指南的综合护理似乎具有成本效益。它有可能改善患者获得联合健康护理的机会，促进综合护理在II型糖尿病管理中的作用，并改善患者教育和自我管理。
