Uptake of Medicare chronic disease items in Australia by general practice nurses and Aboriginal health workers

Abstract

The Australian health care system is currently in a state of reform and there is increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting. In particular, item number 10997 was introduced to reimburse practice nurses and Aboriginal health workers (AHWs) for providing monitoring and support to people with a chronic disease for and on behalf of a general practitioner (GP). The uptake of Medicare Item 100997 from 2007 to 2009, to monitor chronic disease interventions provided by general practice nurses has increased dramatically. The rate of uptake of Item 100997 has not been consistent across States and Territories, even allowing for population distributions. Exploring reasons for these regional variations and linking uptake of Medicare Item numbers to patient outcomes is important in developing the nursing role in Australian general practice. ABSTRACTThe Australian health care system is currently in a state of reform and an increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care models. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting.

Culturally and linguistically diverse general practitioners’ utilisation of practice nurses

“…Being unclear about the financial rebates, coupled with the limited understanding of the potential scope of the PN's roles and functions within the practice were likely to be one explanatory factor for this perception. The concern about the economic benefits of employing PNs is not without basis, in light of the current Medicare structure, whereby only a limited list of nursing activities generate an independent fee-for-service income for the general practice setting (Halcomb, Davidson, & Brown, 2010;Phillips, et al, 2007). This concern is supported by Oldroyd et al (2003) who also reported that the employment of a PN by solo GPs was not affordable despite funding incentives.…”

Australian practice nursing: collaboration in context

“…Insight into what practice nurses do has been gained from analyses of Medicare claim data (Halcomb et al . , Parker et al . , Pearce et al .…”

“…As the practice nursing workforce has grown, more attention has been paid to the activities and characteristics of the role. Insight into what practice nurses do has been gained from analyses of Medicare claim data (Halcomb et al 2010, Parker et al 2010, Pearce et al 2011. While this research has provided insights into practice nurse activity, it is limited to describing the technical activities that practice nurses undertake.…”

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

“…A major distinction between the current state of nursing in general practice within the UK and NZ and the current Australian role is the presence of career frameworks, comprised of salary structures and levels of nursing practice which articulate roles based on the nurses experience, education and scope of practice [7]. In Australia, there remains no defined career pathway [7] and PN roles have been demonstrated to often be linked to funding schemes that provide reimbursement for specific activities [8,9]. …”