Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia?

Heidi Welberry; Margo Linn Barr; Elizabeth J Comino; Ben F Harris-Roxas; Elizabeth Harris; Shona Dutton; Tony Jackson; Debra Donnelly; Mark Fort Harris

doi:10.1186/s12913-019-4663-3

Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia?

BMC Health Serv Res. 2019 Nov 7;19(1):811. doi: 10.1186/s12913-019-4663-3.

Authors

Affiliations

¹ Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW, 2052, Australia.
² Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW, 2052, Australia. margo.barr@unsw.edu.au.
³ Health Equity Research and Development Unit, Sydney Local Health District, NSW, Level 9, King George V Building, PO Box 374, Camperdown, NSW, 2050, Australia.
⁴ The Royal Australian & New Zealand College of Radiologists, Level 9, 51 Druitt Street, Sydney, NSW, 2000, Australia.
⁵ Central and Eastern Sydney Primary Health Network, Tower A, L5, 201 Coward Street, Mascot, NSW, 2020, Australia.
⁶ South Eastern Sydney Local Health District, NSW Health, District Executive Unit, Locked Mail Bag 21, Tarren Point, NSW, 2229, Australia.
⁷ Sydney Local Health District, NSW Health, Level 11, KGV Building, Missenden Road, Camperdown, NSW, 2050, Australia.

Abstract

Background: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years.

Methods: This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P&CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P&CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006-2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage.

Results: Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years.

Conclusions: The use of GPMPs and/or TCAs in the CES area appears well-targeted towards those with chronic and complex care needs. There was no evidence to suggest that the use of GPMPs and /or TCAs has prevented hospitalisations in the CES region.

Keywords: Care plan; Coordinated care; Hospitalisations; Integrated care; Primary health care.

MeSH terms

Aged
Aged, 80 and over
Australia
Chronic Disease / therapy*
Cohort Studies
Emergency Service, Hospital / statistics & numerical data
Female
General Practice / organization & administration*
Health Services Research
Hospitalization / statistics & numerical data*
Humans
Male
Middle Aged
National Health Programs / organization & administration
Patient Care Team / organization & administration*