2010

Authors

  • Richard Iles Richard Iles
  • Diann Eley Diann Eley
  • Desley G. Hegney Desley G. Hegney
  • Elizabeth Patterson Elizabeth Patterson
  • Jacqui Young Jacqui Young
  • Christopher Del Mar Christopher Del Mar
  • Robyn Synnott Robyn Synnott
  • Paul Scuffham Paul Scuffham

Objective To determine the economic feasibility in Australian general practices of using a practice nurse (PN)-led care model of chronic disease magement. Methods A cost-alysis of item numbers from the Medicare Benefit Schedule (MBS) was performed in three Australian general practices, one urban, one regiol 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 magement of their condition over a period of 12 months. After the 12-month intervention, total MBS item charges were evaluated for patients maged 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 alysis 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. What is known about the topic? The integration of practice nurses (PN) into the Australian health system is limited compared with the UK and other parts of Europe. There are known patient benefits of PNs collaborating with general practitioners, especially in chronic disease magement, but the benefits from a fincial perspective are less clear. What does this paper add? The cost-alysis of a PN-led model of chronic disease magement in Australian general practice is reported, providing an indication of the fincial impact of using PNs in primary healthcare. What are the implications for practitioners? Taking into account general practice and individual PN workloads, sufficient funding for employment of PNs is provided by Medicare reimbursements.