Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners

Abstract

Participation of allied health professionals (AHP) in the Enhanced Primary Care (EPC) program is increasing. However, access to allied health services is strictly delineated under the EPC program and AHP face unique practice realities in providing care to patients with chronic conditions. This paper examines the discretionary practices adopted by AHP in response to the realities at the policy-practice interface and situates the discussion within a description of their experiences with EPC. Semistructured telephone interviews were conducted with a purposive sample of fifteen AHP. Participants were selected from a larger cohort who responded to a questionnaire about EPC. The EPC program was perceived as a positive start, although some aspects were problematic. Participants reported that the restriction on the number of subsidised sessions was not conducive to providing a good allied health service to patients with complex care needs and remuneration was not commensurate with the nature and scope of treatment required. The AHP in this study spoke of the dilemma of wanting to assist patients but at the same time to operate a financially viable business. Moreover, their experience was that multidisciplinary team care was implied rather than reality. Abbreviated care practices, reasonable solutions for access, and entrepreneurial practices were strategies used to manage the policy-practice tensions.

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care

“…Research examining allied health perspectives of EPC and CDM items indicates team care is more a paper exercise than a reality, with allied health providers reporting poor liaison and linkages with GPs. 11 The key mechanisms for facilitating team care are the Multidisciplinary Care Plan and the Case Conference items. 6 There is evidence to suggest that in some cases GPs are less inclined to participate in case conferences compared to health assessments and GP Management Plans.…”

Decade of Medicare: The contribution of private practice dietitians to chronic disease management and diabetes group services

“…After a decade of operation, few studies have evaluated the CDM program. Early descriptive studies reported a lack of collaboration and communication between health professionals, particularly between general practices and allied health providers . There was recognition of a need to encourage GPs to engage with the program's team‐based management approach to patient care, which differs from the traditional model of independent care provided by GPs .…”

“…Patient uptake of individual dietetics consultations increased threefold from 2005 (64 000 services) to 2010 (205 000 services). However, in 2010 the utilisation of services across all allied health professions varied widely by geographic region, suggesting that patients' access to local services may not be adequate across all areas of Australia . For example, a NSW case study of six rural general practices observed that dietetics consultations were provided at approximately half the average rate for NSW in 2005–2006 and in 2006–2007 …”

Potential for Information Technology in the Workplace: Investigating the Perceptions of Primary Care Dietitians (Preprint)

“…Australian dietitians report to restrict consultation frequency and length due to insufficient funding under the Australian Medicare scheme [4,8]. Such 'abbreviated care' is of concern for patient health outcomes [4,8].…”

“…Primary healthcare professionals, including dietitians, report challenges in providing effective care due to time and financial constraints under profession-specific requirements [4][5][6][7]. Australian dietitians report to restrict consultation frequency and length due to insufficient funding under the Australian Medicare scheme [4,8].…”