Snowdon David A, Ung David, Collyer Taya A, Lannin Natasha A, Kilkenny Monique F, Thrift Amanda G, Sundararajan Vijaya, Cadilhac Dominique A, Andrew Nadine E
Department of Medicine, Peninsula Clinical School, Central Clinical School, and National Centre for Healthy Ageing, Monash University, 3199 Frankston, Australia.
Department of Neuroscience, Central Clinical School, Monash University, 3004 Melbourne, Australia.
Rev Cardiovasc Med. 2022 Sep 14;23(9):318. doi: 10.31083/j.rcm2309318. eCollection 2022 Sep.
Australian Primary Care Practitioners are incentivised through Medicare funded policies to provide chronic disease management and facilitate multidisciplinary care. Little is known about how these policies are claimed in the long-term management of stroke. The objective of this study was to describe the use of funded primary care policies for people with stroke by impairment status.
Linked Australian Stroke Clinical Registry (2010-2014) and Medicare data from adults with 90-180 days post-stroke EQ-5D health status survey data and admitted to one of 26 participating Australian hospitals were analysed. Medicare item claims for Primary Care Practitioner led chronic disease management and multidisciplinary care coordination policies, during the 18 months following stroke are described. Registrants were classified into impairment groups using their EQ-5D dimension responses through Latent Class Analysis. Associations between impairment and use of relevant primary care policies were explored using multivariable regression.
5432 registrants were included (median age 74 years, 44% female, 86% ischaemic), 39% had a chronic disease management claim and 39% a multidisciplinary care coordination claim. Three latent classes emerged representing minimal, moderate and severe impairment. Compared to minimal, those with severe impairment were least likely to receive chronic disease management (adjusted Odds Ratio (aOR): 0.61, 95% Confidence Interval (CI): 0.49, 0.75) but were most likely to receive multidisciplinary care coordination. Podiatry was the commonest allied health service prescribed, regardless of impairment.
Less than half of people living with stroke had a claim for primary care initiated chronic disease management, with mixed access for those with severe impairments.
澳大利亚初级保健从业者通过医疗保险资助政策，受到激励去提供慢性病管理并促进多学科护理。对于这些政策在中风长期管理中的应用情况，人们知之甚少。本研究的目的是按损伤状况描述中风患者对资助的初级保健政策的使用情况。
对澳大利亚中风临床登记处（2010 - 2014年）与医疗保险数据进行关联分析，这些数据来自中风后90 - 180天进行EQ - 5D健康状况调查且入住26家参与研究的澳大利亚医院之一的成年人。描述了中风后18个月内初级保健从业者主导的慢性病管理和多学科护理协调政策的医疗保险项目申请情况。通过潜在类别分析，利用EQ - 5D维度反应将登记参与者分为损伤组。使用多变量回归探讨损伤与相关初级保健政策使用之间的关联。
纳入5432名登记参与者（中位年龄74岁，44%为女性，86%为缺血性中风），39%有慢性病管理申请，39%有多学科护理协调申请。出现了三个潜在类别，分别代表轻度、中度和重度损伤。与轻度损伤者相比，重度损伤者接受慢性病管理的可能性最小（调整后的优势比（aOR）：0.61，95%置信区间（CI）：0.49，0.75），但接受多学科护理协调的可能性最大。无论损伤程度如何，足病治疗是最常开具的联合健康服务。
不到一半的中风患者申请了由初级保健启动的慢性病管理，重度损伤者的获取情况不一。
