Utilisation of government-subsidised chronic disease management plans and cardiovascular care in Australian general practices.

Genevieve Coorey, Anna Campain, John Mulley, Tim Usherwood, Julie Redfern, Mark Harris, Nicholas Zwar, Sharon Parker, Enrico Coiera, David Peiris

Journal: BMC primary care 2022;23(1):157

PMID: 35729493

Free Full Text on PubMed Central View on PubMed

Abstract

BACKGROUND

Government-subsidised general practice management plans (GPMPs) facilitate chronic disease management; however, impact on cardiovascular disease (CVD) is unknown. We aimed to determine utilisation and impact of GPMPs for people with or at elevated risk of CVD.

METHODS

Secondary analysis of baseline data from the CONNECT randomised controlled trial linked to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) claims. Multivariate regression examining the association of GPMP receipt and review with: (1) ≥ 1 MBS-subsidised allied health visit in the previous 24 months; (2) adherence to dual cardioprotective medication (≥ 80% of days covered with a dispensed PBS prescription); and (3) meeting recommended LDL-cholesterol and blood pressure (BP) targets concurrently.

RESULTS

Overall, 905 trial participants from 24 primary health care services consented to data linkage. Participants with a GPMP (46.6%, 422/905) were older (69.4 vs 66.0 years), had lower education (32.3% vs 24.7% high school or lower), lower household income (27.5% vs 17.0% in lowest bracket), and more comorbidities, particularly diabetes (42.2% vs 17.6%) compared to those without a GPMP. After adjustment, a GPMP was strongly associated with allied health visits (odds ratio (OR) 14.80, 95% CI: 9.08-24.11) but not higher medication adherence rates (OR 0.82, 95% CI: 0.52-1.29) nor meeting combined LDL and BP targets (OR 1.31, 95% CI: 0.72-2.38). Minor differences in significant covariates were noted in models using GPMP review versus GPMP initiation.

CONCLUSIONS

In people with or at elevated risk of CVD, GPMPs are under-utilised overall. They are targeting high-needs populations and facilitate allied health access, but are not associated with improved CVD risk management, which represents an opportunity for enhancing their value in supporting guideline-recommended care.

Address: The George Institute for Global Health, University of New South Wales, Sydney, Australia. [email protected].; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. [email protected].; The George Institute for Global Health, University of New South Wales, Sydney, Australia.; The George Institute for Global Health, University of New South Wales, Sydney, Australia.; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.; The George Institute for Global Health, University of New South Wales, Sydney, Australia.; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.; Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.; School of Population Health, University of New South Wales, Sydney, Australia.; Australian Institute for Health Innovation, Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia.

DOI: 10.1186/s12875-022-01763-2

Link outs

Free resources

Full Text Sources:

MeSH Terms: Aged, Australia, Cardiovascular Diseases, Disease Management, Government, Humans, National Health Programs, United States