Richard A Iles1, Diann S Eley2, Desley G Hegney3, Elizabeth Patterson4, Jacqui Young5, Christopher Del Mar6, Robyn Synnott2, Paul A Scuffham7. 1. School of Accounting, Finance and Economics, Griffith University, 170 Kessels Road, Nathan, Qld 4111, Australia. Email: 2. School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Qld 4006, Australia. Email: 3. Curtin University, School of Nursing and Midwifery, GPO Box U1987, Perth, WA 6845, Australia. Email: 4. Department of Nursing, School of Health Sciences, The University of Melbourne, Room 606, Level 6, Allan Gilbert Building, 161 Barry Street, Melbourne, Vic. 3010, Australia. Email: 5. School of Nursing and Midwifery, The University of Queensland, Herston, Qld 4111, Australia. Email: 6. Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld 4229, Australia. Email: 7. Centre for Applied Health Economics, School of Medicine & Population and Social Health Research Program, Griffith Health Institute, Griffith University, Nathan, Qld 4111, Australia. Email:
Abstract
OBJECTIVE: To determine the economic feasibility in Australian general practices of using a practice nurse (PN)-led care model of chronic disease management. METHODS: A cost-analysis of item numbers from the Medicare Benefit Schedule (MBS) was performed in three Australian general practices, one urban, one regional and one rural. Patients (n =254; >18 years of age) with chronic conditions (type 2 diabetes, hypertension, ischaemic heart disease) but without unstable or major health problems were randomised into usual general practitioner (GP) or PN-led care for management of their condition over a period of 12 months. After the 12-month intervention, total MBS item charges were evaluated for patients managed for their stable chronic condition by usual GP or PN-led care. Zero-skewness log transformation was applied to cost data and log-linear regression analysis was undertaken. RESULTS: There was an estimated A$129 mean increase in total MBS item charges over a 1-year period (controlled for age, self-reported quality of life and geographic location of practice) associated with PN-led care. The frequency of GP and PN visits varied markedly according to the chronic disease. CONCLUSIONS: Medicare reimbursements provided sufficient funding for general practices to employ PNs within limits of workloads before the new Practice Nurse Incentive Program was introduced in July 2012.
RCT Entities:
OBJECTIVE: To determine the economic feasibility in Australian general practices of using a practice nurse (PN)-led care model of chronic disease management. METHODS: A cost-analysis of item numbers from the Medicare Benefit Schedule (MBS) was performed in three Australian general practices, one urban, one regional and one rural. Patients (n =254; >18 years of age) with chronic conditions (type 2 diabetes, hypertension, ischaemic heart disease) but without unstable or major health problems were randomised into usual general practitioner (GP) or PN-led care for management of their condition over a period of 12 months. After the 12-month intervention, total MBS item charges were evaluated for patients managed for their stable chronic condition by usual GP or PN-led care. Zero-skewness log transformation was applied to cost data and log-linear regression analysis was undertaken. RESULTS: There was an estimated A$129 mean increase in total MBS item charges over a 1-year period (controlled for age, self-reported quality of life and geographic location of practice) associated with PN-led care. The frequency of GP and PN visits varied markedly according to the chronic disease. CONCLUSIONS: Medicare reimbursements provided sufficient funding for general practices to employ PNs within limits of workloads before the new Practice Nurse Incentive Program was introduced in July 2012.
Authors: Julia Lukewich; Ruth Martin-Misener; Allison A Norful; Marie-Eve Poitras; Denise Bryant-Lukosius; Shabnam Asghari; Emily Gard Marshall; Maria Mathews; Michelle Swab; Dana Ryan; Joan Tranmer Journal: BMC Health Serv Res Date: 2022-06-03 Impact factor: 2.908
Authors: Julia Lukewich; Shabnam Asghari; Emily Gard Marshall; Maria Mathews; Michelle Swab; Joan Tranmer; Denise Bryant-Lukosius; Ruth Martin-Misener; Allison A Norful; Dana Ryan; Marie-Eve Poitras Journal: BMC Health Serv Res Date: 2022-04-04 Impact factor: 2.655