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Claims of sub-standard chronic care ‘blatantly wrong’

Claims of sub-standard chronic care ‘blatantly wrong’ - Featured Image

The AMA has hit back at “blatantly wrong” claims that GPs are failing to adequately care for patients with chronic illnesses.

AMA Council of General Practice Chair Dr Brian Morton said that although there was “no doubt” management of chronic disease could be improved, a Grattan Institute study accusing GPs of serial shortcomings in their care of patients with chronic illnesses including diabetes, asthma, heart disease and mental illness, was flawed.

Using data drawn from 162 medical practices using the Medical Director patient management system, the report, Chronic failure in primary care, claims that just 15 per cent of diabetic patients had their blood glucose, weight and blood pressure checked every year, less than 30 per cent with high blood pressure had it adequately managed and two-thirds of patients with a mental illness missed out on care.

But Dr Morton strongly disputed the findings, which he said did not stand up to scrutiny.

For instance, he said, the proportion of Australians admitted to hospital with uncontrolled diabetes was 7.5 per 100,000 – one of the lowest rates among rich countries and well below the United Kingdom (23.9 per 100,000).

Related: Grattan primary care report right, says GP

The Grattan Institute report itself admitted the paucity of data available to assess the effectiveness of the primary health system in managing complex and chronic disease, which Dr Morton said meant its analysis and conclusions must be treated with caution.

The report’s author, Professor Hal Swerrison, used the findings of the report to argue that the Government was getting a poor return on the $1 billion a year it provided to GPs to prepare chronic disease plans and conduct health assessments.

To rectify this, Professor Swerrison recommended that Medicare rebates be frozen at current levels and funds currently provided through the Practice Incentives Program, Service Incentive Payments and other sources to support chronic disease management be instead combined into an annual $40,000 payment to practices based on achieving performance targets and health outcomes.

A similar model was considered in the Primary Health Care Advisory Group report presented to Health Minister Sussan Ley late last year, as well as a blended model of fee-for-service and so-called capitation payments. The Minister is yet to formally respond to the report.

Related: MJA – Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial

In its submission to the Primary Health Care Advisory Group, the AMA expressed support for a blended payment model and reform of Medicare chronic disease items to strengthen the role of a patient’s GP, cut red tape, streamline access to allied health care and reward longitudinal care.

Dr Morton said any changes to the model of care needed to be carefully considered and tested before being introduced, and a much more urgent priority was to lift the freeze on Medicare rebates.

“The burden of complex and chronic disease in this country continues to grow, and the Government needs to take a long-term view if it is to tackle this problem effectively,” he said. “The Government needs to invest significantly in general practice, [including] immediately lifting the current freeze on the indexation of Medicare rebates.”

He said the Grattan Institute report also highlighted the need for much better primary health care data: “There is very little data as to what actually works in Australia in the primary care space. Yes, we need data, and we need to collect it.”

Related: Meeting end-of-life care needs for people with chronic disease: palliative care is not enough

The AMA has proposed a PIP incentive payment to support quality improvement, “informed by better data collection”.

Last month, pharmacists outlined the scope of their ambitions for involvement in the provision of health services, particularly chronic care.

Pharmacy Guild of Australia Executive Director David Quilty told a parliamentary inquiry into chronic disease prevention and management that pharmacies could play an “enhanced role” in a number of areas including: transitional care, continued dispensing and prescription renewal, treatment of minor ailments, vaccination, medicine adherence, point of care testing, risk assessments, early intervention, broader diabetes management, treatment of patients through biologics, asthma support, improved after-hours access to primary health care, illicit drug use and the use of pharmacies as rural health hubs, with a strong focus on triage services.

While the AMA has highlighted the risk to patients of allowing pharmacists to administer vaccines, conduct health tests and provide other services outside their scope of expertise, it has proposed the introduction of non-dispensing pharmacists in general practices as a way to help improve medication management, particularly for the chronically ill.

Adrian Rollins