2. More Time with the Doctor: Chronic Disease Management
The recent AIHW Australia’s Health 2010 report confirms that GPs are increasingly treating older patients with more complex care needs. The management of chronic and complex disease is a key part of general practice, with at least one chronic problem managed in 42 per cent of all visits to a GP.
The report also highlights that the chronic problems most managed by GPs are hypertension, depressive disorder, diabetes, cholesterol-related disorders, chronic arthritis, oesophageal disease, and asthma. We also know that many patients are suffering from multiple illnesses.
Australia needs a comprehensive approach to the management of chronic and complex illness, not just a focus on single diseases as in the current Government’s proposed plan for diabetes.
The medical profession was not properly consulted on the current Government’s proposed program to deliver GP care for patients with diabetes. This program relies on patient enrolment with the practice and, once enrolled, limits patient choice. It interferes with the doctor-patient relationship and requires patients to surrender their entitlement to Medicare rebates.
As highlighted earlier, research commissioned by the AMA shows that patients want to spend more time with their GP. The current structure of the MBS does not support more time with the doctor, with patients on average spending about 15 minutes with their GP each time they visit.
Improved access to GP-referred allied health and other support services can improve the management of chronic and complex disease and enhance people’s quality of life.
At the same time, the health system must also encourage individual patients to take some responsibility for their own health and wellbeing, based on the advice they receive from their GP, including on secondary prevention measures.
GPs could keep more patients with chronic and complex disease out of hospital if they could access better support for their patients. This would save the health system money and relieve some pressure on the hospital system.
In addition, Governments should have a strong health prevention focus as part of their health care policy. Providing patients with an MBS rebate structure that supports longer consultations would ensure that patients with chronic and complex conditions get the time that they need with their doctor.
The AMA has a comprehensive plan to manage chronic and complex disease by improving GP-coordinated access to multidisciplinary care and other important support services. It can be found on the AMA website at www.ama.com.au/node/5519
The AMA plan builds on what works and has the overwhelming support of GPs. Under this plan, existing fee-for-service Medicare arrangements would be enhanced so that patients would have streamlined access to GP-referred allied health services and a range of other support services, such as mobility aids. The plan focuses on patients’ clinical needs and ensures that more support is available to those patients who need it. Unlike the Government’s proposed program, the AMA’s plan does not require patients to surrender their right to Medicare rebates.
The next Government must:
- Negotiate with the medical profession and then implement the AMA plan to manage chronic and complex disease; and
- Increase the Medicare patient rebate for level C and D consultation items in the MBS to support improved care for patients with chronic and complex conditions. This will improve patient access to longer consultations. Funding allocated to the current Government’s diabetes plan should be redirected and used for this purpose.
* For a full pdf version of the Key Health Issues for the 2010 Federal Election click here
Key Health Issues for the 2010 Federal Election - Foreword – AMA President, Dr Andrew Pesce
AMA National Conference 2012
Federal Budget Submission 2012-13
Traffic Light Food Labelling - The Evidence
Poll
Diabetes Care Plan.
After 45 years with the one Clinic I have recently changed to another Clinic closer to home, I am a type2 diabetes insulin depnedent patient, I have had two TIA's, and also have advanced Osteo Arthritis, and chronic elevated Choleserol levels. My new doctor is keen to sign me up to the Care Plan, but luckily I saw an article currently in the Australian newspaper outling the AMA's objection to the plan, and the Government's refusal to allow the AMA to sit on the Committee if it "totally opposes the plan". I pointed out to the doctor my concerns about the plan: the possibility of losing my Medicare Rebates, but the doctor, despite not knowing of the AMA's concerns wanted to assure me that "such was not the case". "I could commit to the plan now, and what happened from here on would have no retrospectivity, that it would only affect those joining after the plan was introduced". I am sceptical, and erred on the side of caution, advising the doctor I would like to wait to see how it all played out.
Questions? Is the doctor correct? or am I correct to wait, and see?
Re: Diabetes Care Plan
Dear Mr Williamson
Thank your for query regarding the Diabetes Care Plan. The Government's proposed plan for funding diabetes care is not due to commence until July 2012.
The plan your GP would have wanted to prepare for you is the existing GP Management Plan. While these plans do involve a lot of red tape for GPs, they are for the management of patients with a chronic disease, such as your type 2 diabetes. Having a GP Management Plan (MBS Item 721) prepared for you will not affect your Medicare entitlements. If your GP believes you would benefit from having a GP Management Plan prepared for you, then you should consider agreeing.
Having a 'structured approach to your health care' plan in place will enable you and your usual family doctor to better manage your health care needs. In addition, if your family doctor determines it appropriate, the plan may provide a pathway for you to additional allied health services. Medicare will provide rebates for the plan, and up to five nominated allied health services each year.
I suggest you discuss the matter further with your GP at your next consultation.
Yours sincerely
Dr Steve Hambleton
Vice President
Diabetes Care Plan.
Dear Dr Hambleton,
thank you very much for taking the time to respond to my concerns regarding the "proposed" Diabetes Care Plan, I am now in a quandry as to why my Dr did not explain it to me in the way that you have? Perhaps she misunderstood exactly which plan I was referring to?
I am most grateful for your re-assurances, and will certainly discuss it further with my doctor.
Yours sincerely
Merv. Williamson.
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