Variation in levels of uptake of Enhanced Primary Care item numbers between medical practices, within Divisions of General Practice and jurisdictions

2002 ◽  
Vol 25 (6) ◽  
pp. 122
Author(s):  
David Wilkinson ◽  
Heather McElroy ◽  
Justin Beilby ◽  
Kathy Mott ◽  
Kay Price ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
National Level ◽  
Substantial Variation ◽  
Medical Practices ◽  
Care Plans ◽  
Health Assessments ◽  
Case Conferences ◽  
Almost All ◽  
Control Limits

We aimed to report on variation in levels of uptake of services between medical practices across Divisions of General Practice, and jurisdictions, through the Enhanced Primary Care (EPC) program between November 1999 and October 2001.No Divisions had levels of EPC uptake outside upper control limits plus/minus three standard deviations the national level, suggesting limited substantial systematic variation relating to high uptake. Four Divisions had rates of practices providing EPC services (33.3%-67.7%)substantially lower than the national rate (81.2%). For all EPC services combined and for health assessments (HAs) there is substantial variation between practices in almost all Divisions of General Practice, and in some this is extreme. For care plans (CPs), while several Divisions show wide variation in rates across practices (and in a few there is extreme variation), in other Divisions there are very low rates of CP across all practices. For case conferences (CCs) the picture is even more extreme, and these patterns are expressed across all jurisdictions. There is substantial variation in the level of uptake of EPC services across medical practices in Australia.

scholarly journals Variation between Divisions of General Practice in the uptake of health assessments, care plans and case conferences through the Enhanced Primary Care program

2002 ◽  
Vol 25 (6) ◽  
pp. 119
Author(s):  
David Wilkinson ◽  
Heather McElroy ◽  
Justin Beilby ◽  
Kathy Mott ◽  
Kay Price ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Total Population ◽  
Care Program ◽  
Care Plans ◽  
Eligible Population ◽  
Primary Care Program ◽  
Health Assessments ◽  
Case Conferences ◽  
Second Year

We aimed to describe the variation in rates of uptake of the enhanced primary care (EPC) Medicare Benefits Schedule items for health assessments (HA), care plans (CP) and case conferences (CC), between Divisions of General Practice from November 1999 (when these items first became available) to October 2001.There was substantial variation in uptake of the various EPC services between Divisions of General Practice, ranging from very low to high. For HA the rate in the highest uptake Division was 496 per 1000 eligible population, and the lowest was zero. There are seven Divisions with high and six with very low uptake, with the rest ranging between 100 and 400/1000.Five Divisions had CP rates over 15/1000 total population; most Divisions had fewer than 10/1000,and many had less than 5/1000.A similar pattern is observed for CC. The levels of uptake for HA increased in the second year of the program for all but eight Divisions of General Practice, and the levels of uptake for CP increased in all but two Divisions. In the first two years of availability, uptake has been highly variable across Divisions of General Practice. Uptake has however increased substantially and consistently in the second year of the program.

scholarly journals Characteristics of patients receiving health assessments, care plans or case conferences by general practitioners, as part of the Enhanced Primary Care program between November 1999 and October 2001

2002 ◽  
Vol 25 (6) ◽  
pp. 120
Author(s):  
David Wilkinson ◽  
Heather McElroy ◽  
Justin Beilby ◽  
Kathy Mott ◽  
Kay Price ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Indigenous People ◽  
Care Program ◽  
The Elderly ◽  
Care Plans ◽  
Department Of Health ◽  
Health Assessments ◽  
Case Conferences ◽  
Gender Patterns

We aimed to describe the characteristics of patients receiving health assessments (HA), care plans (CP) or case conferences (CC) through the Enhanced Primary Care (EPC) program between November 1999 and October 2001. The Commonwealth Department of Health and Ageing provided data. In all, 43%of non-Indigenous people who had a HA were aged 75-79 years and 32%were aged 80-84 years. Those having a HA at home were older (30.3% aged 85 years and above) than those having a HA in GP's rooms (20.2%85 years and above). For Indigenous people, between 12 and 17%of all HAs were done among each five-year age group between 55 and 84 years. As a group, CPs were mostly done among older people, with a higher proportion done among older women (74.2%among those 55 years and above) than older men (66.4%). Most CCs were also done among older people (60.4%55 years and above). Of the 286,250 people that had at least one EPC service, most (219,210; 76.6%)had only one. Of these, 153,624 (70.1%)had a HA. Of those having at least one EPC service, 95.7%had two services (most often a HA plus a CP). To date EPC activity has been concentrated among the elderly, gender patterns are similar, and few patients have received more than a single EPC service, which is usually a HA.

scholarly journals Characteristics of general practitioners that provided health assessments, care plans or case conferences, as part of the Enhanced Primary Care program

2002 ◽  
Vol 25 (6) ◽  
pp. 121 ◽  
Author(s):  
David Wilkinson ◽  
Heather McElroy ◽  
Justin Beilby ◽  
Kathy Mott ◽  
Kay Price ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Care Program ◽  
First Year ◽  
Care Plans ◽  
Primary Care Program ◽  
Wide Range ◽  
Health Assessments ◽  
Case Conferences ◽  
Second Year

We aimed to describe the characteristics of general practitioners (GPs) who provided health assessments (HA), care plans (CP) or case conferences (CC) as part of the Enhanced Primary Care (EPC) program between November 1999 and October 2001.While the gender distribution of EPC-active GPs is similar to that of non-EPC-active GPs, EPC-active GPs tend to be younger (72% vs 58% aged 35-54 years). Among EPC-active GPs, males account for about 66% of providers and about 80%of services. There is a very wide range in the number of EPC services provided per GP. In all, 1591 (14%)have rendered a single service while 919 (8.1%)have rendered over 100 services each (accounting for almost half of all EPC activity in Australia). The number of GPs providing any EPC service each month gradually increased to around 5000 in October 2001.Most patients (80-90%)that received multiple EPC services did so from the same GP. Across Divisions of General Practice the proportion of practices registered for the Practice Incentive Program (PIP) that have provided EPC services ranges from 100 to 0%. In the first year at least 50% of all practices in 84 Divisions rendered at least one EPC service while in the second year 108 did. Across Australia 58% of PIP practices rendered at least one service in the first year and 76% did in the second year. A little over half the GP workforce rendered at least one EPC service in the first year of the program, but there was a very wide range in the number of services provided per GP. Most GPs provide very few and a small number provide very many. There is wide variation in the proportion of practices providing EPC services, but this is increasing.

scholarly journals Variation in levels of uptake of Enhanced Primary Care item numbers between rural and urban settings, November 1999 to October 2001

2002 ◽  
Vol 25 (6) ◽  
pp. 123 ◽  
Author(s):  
David Wilkinson ◽  
Heather McElroy ◽  
Justin Beilby ◽  
Kathy Mott ◽  
Kay Price ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Urban Areas ◽  
South Australia ◽  
Full Time ◽  
Full Time Equivalent ◽  
Care Plans ◽  
Rural And Urban ◽  
Wide Range ◽  
Health Assessments

We aimed to report on variation in levels of uptake of enhanced primary care item numbers between rural and urban Divisions of General Practice between November 1999 and October 2001.Most providers of EPC services and most services (close to 70%)are located in capital cities and other metropolitan centres. The average number of health assessments done per provider was slightly lower (8-14) in remote than urban and rural (20-30) areas. A similar pattern was observed for care plans, but rates of case conferences were similar in rural and urban areas. However, adjusted for population aged 75 years and over, in all jurisdictions except South Australia, between 30% and 144% more health assessments were done per full time equivalent general practitioner (FTE GP) in rural divisions. For rural and urban Divisions of General Practice, there is a wide range in the rate of services provided, between and within Divisions. However, overall, more services are provided per FTE GP in rural Divisions.

scholarly journals Exploring the multiple policy objectives for primary care networks: a qualitative interview study with national policy stakeholders

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038398
Author(s):  
Kath Checkland ◽  
Jonathan Hammond ◽  
Lynsey Warwick-Giles ◽  
Simon Bailey
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Service Delivery ◽  
Service Providers ◽  
National Level ◽  
National Policy ◽  
Document Analysis ◽  
Policy Document ◽  
Qualitative Interview Study ◽  
Policy Objectives

ObjectivesEnglish general practice is suffering a workforce crisis, with general practitioners retiring early and trainees reluctant to enter the profession. To address this, additional funding has been offered, but only through participation in collaborations known as primary care networks (PCNs). This study explored national policy objectives underpinning PCNs and the mechanisms expected to help achieve these, from the perspective of those driving the policy.DesignQualitative semistructured interviews and policy document analysis.Setting and participantsNational-level policy maker and stakeholder interviewees (n=16). Policy document analysis of the Network Contract Direct Enhanced Service draft service specifications.AnalysisInterviews were transcribed, coded and organised thematically according to policy objectives and mechanisms. Thematic data were organised into a matrix so prominent elements can be identified and emphasised accordingly. Themes were considered alongside objectives embedded in PCN draft service delivery requirements.ResultsThree themes of policy objectives and associated mechanisms were identified: (1) supporting general practice, (2) place-based interorganisational collaboration and (3) primary care ‘voice’. Interviewees emphasised and sequenced themes differently, suggesting meeting objectives for one was necessary to realise another. Interviewees most closely linked to primary care emphasised the importance of theme 1. The objectives embedded in draft service delivery requirements primarily emphasised theme 2.ConclusionsThese policy objectives are not mutually exclusive but may imply different approaches to prioritising investment or necessitate more explicit temporal sequencing, with the stabilisation of a struggling primary care sector probably needing to occur before meaningful engagement with other community service providers can be achieved or a ‘collective voice’ is agreed. Multiple objectives create space for stakeholders to feel dissatisfied when implementation details do not match expectations, as the negative reaction to draft service delivery requirements illustrates. Our study offers policy makers suggestions about how confidence in the policy might be restored by crafting delivery requirements so all groups see opportunities to meet favoured objectives.

scholarly journals Access to rural general practice and primary care: Time now for more equitable and sustainable solutions?

2004 ◽  
Vol 10 (3) ◽  
pp. 160
Author(s):  
Sam Heard
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Sustainable Solutions ◽  
Basic Service ◽  
Almost All

Australia has the resources to provide reasonable primary medical and health care to all of its population. It is a particularly worthwhile expense, with positive social and biophysical outcomes (Jarman et al., 1999; Starfield, 1998). In many aspects of health care, primary care provides most of the benefit and almost all of the value. Why, then, don?t we provide this basic service to all Australians?

Findings from a clinical audit in regional general practice of management of patients following acute coronary syndrome

2017 ◽  
Vol 23 (2) ◽  
pp. 170
Author(s):  
Mithilesh Dronavalli ◽  
Manavi M. Bhagwat ◽  
Sandy Hamilton ◽  
Marisa Gilles ◽  
Jacquie Garton-Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Care Plans ◽  
Coronary Syndrome ◽  
Diet And Exercise ◽  
National Heart Foundation ◽  
To Receive ◽  
Heart Foundation

Patients with acute coronary syndrome (ACS) require ongoing treatment and support from their primary care provider to modify cardiovascular risk factors (including diet, exercise and mood), to receive evidence-based pharmacotherapies and be properly monitored and to ensure their take-up and completion of cardiac rehabilitation (CR). This study assesses adherence to National Heart Foundation guidelines for ACS in primary care in a regional centre in Western Australia. Patients discharged from hospital after a coronary event (unstable angina or myocardial infarction) or a coronary procedure (stent or coronary artery bypass graft) were identified through general practice electronic medical records. Patient data was extracted using a data form based on National Heart Foundation guidelines. Summary statistics were calculated and reported. Our study included 22 GPs and 44 patients in a regional centre. In total, 90% (n=39) of discharge summaries recorded medications. Assessment of pharmacological management showed that 53% (n=23) of patients received four or more classes of pharmacotherapy and that GPs often augmented medication beyond that prescribed at discharge. Of 15 smokers, 13 (87%) had advice to quit documented. Minimal advice for other risk-factor modification was documented in care plans. Patients with type 2 diabetes (n=20) were 70% more likely to receive allied health referral (P=0.02) and 60% more likely to receive advice regarding diet and exercise (P=0.007). However, overall, only 30% (n=13) of those eligible were referred to a dietician, and only 25% were referred to CR (n=10) with six completing CR. Although most GPs did not use standardised tools for mood assessment, 18 (41%) patients were diagnosed as depressed, of which 88% (n=16) were started on antidepressants and 28% (n=6) were referred to a psychologist. Although pharmacotherapy, mood management and smoking cessation management generally followed recommended guidelines, risk factor management relating to diet and exercise by GPs require improvement. Detailed care plans and referral to CR and allied health staff for patient support is recommended.

Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education

2016 ◽  
Vol 22 (2) ◽  
pp. 113 ◽  
Author(s):  
Christine M. Hallinan ◽  
Kelsey L. Hegarty
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Nursing Education ◽  
Chronic Disease ◽  
Postgraduate Education ◽  
Scope Of Practice ◽  
Care Plans ◽  
Postgraduate Studies ◽  
Care Nursing ◽  
Primary Care Nursing

The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.

scholarly journals Trends and variation in unsafe prescribing of methotrexate: a cohort study in English NHS primary care

2020 ◽  
Vol 70 (696) ◽  
pp. e481-e488 ◽  
Author(s):  
Brian MacKenna ◽  
Helen J Curtis ◽  
Alex J Walker ◽  
Richard Croker ◽  
Seb Bacon ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
National Level ◽  
Freedom Of Information ◽  
Substantial Variation ◽  
England And Wales ◽  
National Guidance ◽  
High Doses ◽  
Over Time

BackgroundPrescribing high doses of methotrexate increases the potentially fatal risk of toxicity. To minimise risk, it is recommended that only 2.5 mg tablets are used.AimTo describe trends in GP prescribing of methotrexate over time; the harm associated with methotrexate errors at a national level; ascertain variation between practices and clinical commissioning groups (CCGs) in their implementation of the safety guidance; and map current variations at CCG and practice level.Design and settingA retrospective cohort study of English GP prescribing data (August 2010–April 2018), and data acquired via freedom of information (FOI) requests.MethodThe main outcome measures were: variation in ratio of non-adherent/adherent prescribing, geographically and over time, between practices and CCGs; and description of responses to FOI requests.ResultsOf 7349 practices in England, 1689 prescribed both 2.5 mg and 10 mg tablets to individual patients in 2017, breaching national guidance. In April 2018, 697 practices (≥90th percentile) prescribed >14.3% of all methotrexate as 10 mg tablets, likewise breaching national guidance. The 66 practices at ≥99th percentile gave >52.4% of all prescribed methotrexate in the form of 10 mg tablets. The prescribing of 10 mg tablets fell during the study period, with 10 mg tablets as a proportion of all prescribed methotrexate tablets falling from 9.1% to 3.4%. Twenty-one deaths caused by methotrexate poisoning were reported from 1993–2017 in England and Wales.ConclusionThe prevalence of unsafe methotrexate prescribing has reduced but remains common, with substantial variation between practices and CCGs. The authors recommend investment in better strategies around implementation. As 21 deaths that occurred from 1993–2017 in England and Wales were attributed to methotrexate poisoning, the coroners’ reports for these deaths should be reviewed to identify recurring themes.

Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review

2020 ◽  
pp. bmjspcare-2019-002109 ◽  
Author(s):  
Joel J Rhee ◽  
Matthew Grant ◽  
Hugh Senior ◽  
Leanne Monterosso ◽  
Peta McVey ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
End Of Life ◽  
Low Income ◽  
End Of Life Care ◽  
National Level ◽  
Aged Care ◽  
Life Care ◽  
Structural Barriers ◽  
Facilitators And Barriers

BackgroundGeneral practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. To enhance primary EoLC, the facilitators and barriers to their provision need to be understood.ObjectiveTo provide a comprehensive description of the facilitators and barriers to GP and GPN provision of PC or EoLC.MethodSystematic literature review. Data included papers (2000 to 2017) sought from Medline, PsycInfo, Embase, Joanna Briggs Institute and Cochrane databases.ResultsFrom 6209 journal articles, 62 reviewed papers reported the GP’s and GPN’s role in EoLC or PC practice. Six themes emerged: patient factors; personal GP factors; general practice factors; relational factors; co-ordination of care; availability of services. Four specific settings were identified: aged care facilities, out-of-hours care and resource-constrained settings (rural, and low-income and middle-income countries). Most GPs provide EoLC to some extent, with greater professional experience leading to increased comfort in performing this form of care. The organisation of primary care at practice, local and national level impose numerous structural barriers that impede more significant involvement. There are potential gaps in service provision where GPNs may provide significant input, but there is a paucity of studies describing GPN routine involvement in EoLC.ConclusionsWhile primary care practitioners have a natural role to play in EoLC, significant barriers exist to improved GP and GPN involvement in PC. More work is required on the role of GPNs.

Sign in / Sign up

Export Citation Format

Share Document