'The onus is on me': primary care patient views of Medicare-funded team care in chronic disease management in Australia.

BACKGROUND AND
OBJECTIVE: This study investigated the views of primary care patients in receipt of Medicare-funded team care for chronic disease management (CDM) in Australia.
DESIGN: A qualitative study using a repeat in-depth interview design. PARTICIPANTS AND
SETTING: Twenty-three patients (17 female), aged 32-89, were recruited over a six-month period from two purposively selected general practices: one urban and one regional practice in Queensland, Australia. DATA COLLECTION PROCEDURE: Semi-structured interviews were conducted with participants 6 months apart. An interview guide was used to ensure consistency of topics explored. Interviews were recorded and transcribed, and a thematic analysis was conducted.
RESULTS: Patients in this study viewed the combined contributions of a GP and other health professionals in team care as thorough and reassuring. In this case of Medicare-funded team care, patients also saw obligations within the structured care routine which cultivated a personal ethics of CDM. This was further influenced by how patients viewed their role in the health-care relationship. Aside from personal obligations, Medicare funding got patients engaged in team care by providing financial incentives. Indeed, this was a defining factor in seeing allied health professionals. However, team care was also preferential due to patients' valuations of costs and benefits.
CONCLUSION: Patients are likely to engage with a structured team care approach to CDM if there is a sense of personal obligation and sufficient financial incentive. The level of engagement in team care is likely to be optimized if patient expectations and preferences are considered in decisions.