The feasibility, acceptability and sustainability of nurse-led chronic disease management in Australian general practice: The perspectives of key stakeholders

2013 ◽  
Vol 19 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Desley G Hegney ◽  
Elizabeth Patterson ◽  
Diann S Eley ◽  
Rosemary Mahomed ◽  
Jacqui Young
Keyword(s):  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Key Stakeholders ◽  
Australian General Practice

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice

2013 ◽  
Vol 19 (2) ◽  
pp. 150 ◽  
Author(s):  
Diann S. Eley ◽  
Elizabeth Patterson ◽  
Jacqui Young ◽  
Paul P. Fahey ◽  
Chris B. Del Mar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Models Of Care ◽  
Practice Nurses ◽  
Australian General Practice ◽  
General Practices

The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model’s feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients’ stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

Nurses in Australian general practice: implications for chronic disease management

2008 ◽  
Vol 17 (5a) ◽  
pp. 6-15 ◽  
Author(s):  
Elizabeth J Halcomb ◽  
Patricia M Davidson ◽  
Yenna Salamonson ◽  
Richard Ollerton ◽  
Rhonda Griffiths
Keyword(s):  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Australian General Practice

Building quality chronic illness care: implementation of a web-based care plan

2020 ◽  
Vol 26 (2) ◽  
pp. 173
Author(s):  
Shiva Vasi ◽  
Jenny Advocat ◽  
Akuh Adaji ◽  
Grant Russell
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
New Technologies ◽  
Participant Observation ◽  
Care Plan ◽  
Structured Interviews ◽  
Structured Approach

Structured, multidisciplinary approaches to chronic disease management (CDM) in primary care, supported by eHealth tools, show improved clinical outcomes, yet the uptake of eHealth tools remains low. The adoption of cdmNet, an eHealth tool for chronic disease management, in general practice settings, was explored. This was a qualitative case study in three general practice clinics in Melbourne, Australia. Methods included non-participant observation, reflexive note taking and semi-structured interviews with GPs, non-GP clinical staff, administrative staff and patients with chronic conditions. Data were analysed iteratively and results were reviewed at regular team meetings. Findings highlighted the significance of clinical and organisational routines in determining practice readiness for embedding innovations. In particular, clinical routines that supported a structured approach to CDM involving team-based care, allocation of resources, training and leadership were fundamental to facilitating the adoption of the eHealth tool. Non-GP roles were found to be key in developing routines that facilitated the adoption of cdmNet within a structured approach to CDM. Practice managers, administrators and clinicians should first focus on routinising processes in primary care practices that support structured and team-based processes for CDM because without these processes, new technologies will not be embedded.

scholarly journals Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia

2010 ◽  
Vol 34 (2) ◽  
pp. 162 ◽  
Author(s):  
Derek P. Chew ◽  
Robert Carter ◽  
Bree Rankin ◽  
Andrew Boyden ◽  
Helen Egan
Keyword(s):  
Coronary Heart Disease ◽  
General Practice ◽  
Heart Disease ◽  
Chronic Disease ◽  
Cost Effectiveness ◽  
Disease Management ◽  
Financial Incentives ◽  
Chronic Disease Management ◽  
Cost Effective ◽  
Disease Registry

Background.The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model. Methods.A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented. Results.Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program’s ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis. Conclusions.Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community. What is known about this topic?Chronic disease management programs are known to provide gains with respect to reductions in death and disability among patients with coronary heart disease. The cost effectiveness of such programs in the Australian context is not known. What does this paper add?This paper suggests that implementing a coronary heart disease program in Australia is highly cost-effective across a broad range of assumptions of uptake and effectiveness. What are the implications for practitioners? These data provide the economic rationale for the implementation of a chronic disease management program with a disease registry and regular review in Australia.

A new political anatomy of the older body? An examination of approaches to illness in old age in primary care

2012 ◽  
Vol 33 (6) ◽  
pp. 964-987 ◽  
Author(s):  
SUSAN PICKARD
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Old Age ◽  
Older Patients ◽  
Chronic Disease Management ◽  
Geriatric Medicine ◽  
Evidence Based ◽  
Practice Nurses

ABSTRACTThis paper examines the new approaches to older bodies found within primary care, with the purpose of determining whether they represent a significant disjunction from established approaches in geriatric medicine. A genealogical review of clinical approaches to certain conditions commonly found in old age is undertaken utilising (a) key texts of pioneering British geriatricians and (b) three editions of a key textbook of general practice, published between 1989 and 2009. The discourses and practices established by the Quality and Outcome Frameworks in England are then examined, focusing on evidence-based guidance for these same conditions. Following this excavation of written texts, empirical data are analysed, namely the accounts of general practitioners and practice nurses regarding application of the technologies associated with chronic disease management to older patients. Continuities and changes identified by these practitioners are explored in terms of three specific consequences, namely conceptualising and treatment of older bodies and interaction with patients. The paper's conclusion considers whether these changes are significant enough to warrant describing them as representative of an epistemic rupture or break in the way older bodies are perceived, both in medicine and also in society more generally, and thus of constituting a new political anatomy of the older body.

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