Policy Issue Review
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ItemCorporatisation of general practice — Impact and implications(Primary Health Care Research & Information Service, 2016-08)In Australia, general practice is largely private, ranging from small sole traders through to large partnerships comprising six or more practitioners. Over time, a number of corporate practices, which are registered under the Corporations Act 2001, have emerged on the Australian health care landscape. The corporate model also varies in size, depending on location (urban, rural) and types of services provided by the company. This review examines the impact and implications of corporatisation of general practice in Australia in terms of market competition, quality of care, patient outcomes, costs of care, and the health care workforce.
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ItemRegionalisation of health services: Benefits and impact(Primary Health Care Research & Information Service, 2016-06)Providing a well-integrated, cost-effective, quality health care system that meets the needs of the population is challenging for governments worldwide. In Australia, this challenge is complicated by a geographically and culturally diverse population; and complex funding and responsibilities across different levels of government. Regionalisation in health care is about enabling appropriate allocation and integration of resources according to the local population health needs, and community engagement and quality improvement to optimise delivery. From a governance perspective, control and accountability for allocation of resources and delivery of services may be centralised, decentralised, or a mixture of both. This review examines the different approaches that have been used in Australia; and assesses what is known of their effectiveness in terms of: patient health outcomes and experience, cost containment, economies of scale, accountability, citizen participation in decision-making, integration of services, and quality and equity of care. An overview of the current global trends in regionalisation is also presented.
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ItemThe role of primary health care in primary and secondary prevention of diabetes(Primary Health Care Research & Information Service, 2015)In Australia, diabetes represents a major burden in both human and financial terms, drawing heavily on limited health care resources including trained staff and carers. In contrast to many other health conditions, evidence suggests that many aspects of the burden imposed by diabetes could be avoided through preventive measures. Type 1 diabetes mellitus (T1DM) is a genetically linked autoimmune disease and there is currently no known prevention. However, the risk for complications associated with T1DM can be reduced by optimal management of blood glucose levels. Type 2 diabetes mellitus (T2DM) accounts for over 85 per cent of all diabetes in Australia. Obesity is a major contributor to the development of T2DM and weight loss has been shown to reduce the incidence of T2DM in people with impaired glucose tolerance (IGT). Therefore, primary prevention of T2DM has generally focused on weight loss and lifestyle interventions, while secondary prevention to reduce the risk of diabetes-related complications centres on use of pharmacotherapy in addition to diet and lifestyle interventions to manage surrogate markers of complication risk (e.g. blood glucose levels, blood pressure, and lipid levels). The aim of this research is to examine diabetes programmes reporting outcome data and used in general practice settings to identify and proactively manage individuals at high risk for developing diabetes; or where diabetes is diagnosed, at risk for development of, or deterioration in, diabetes-related complications. Comparison of programme structure with published evidence is used together with outcome data to assess programmes.
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ItemTelehealth in primary health care settings within Australia and internationally(Primary Health Care Research Information Service, 2013)Access to appropriate health care services is often limited for people living in rural or remote areas, or for those with restricted mobility. One approach to minimising the inequality in access for those located at a distance from health care services is through telehealth service delivery. This review examined the evidence on telehealth models in Australia and elsewhere, with a specific focus on synchronous, real-time video consultations, where patients and health care providers were present simultaneously.
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ItemQuality improvement financial incentives for general practitioners(Primary Health Care Research & Information Service, 2014)This report reviews outcomes of intervention programmes targeting reductions in potentially avoidable hospitalisations (PAHs) and/or avoidable Emergency Department presentations (ED presentations) among people with chronic disease. The focus is on the role of primary health care and where possible programmes targeting specific vulnerable populations, namely Indigenous Australians, rural and remote residents and those at socioeconomic disadvantage. This report also aimed to examine tQuality improvement includes aspects of self-reflection and benchmarking, with continued evaluation to identify where additional improvements to practice can be made. Measures of the quality of care are typically structure (e.g. related to an organisation’s operations), process (e.g. clinical guidelines or care pathways) or outcomes-based (e.g. physiological indicators). Improvements can be measured in relative or absolute terms. The likelihood of engaging with incentives and the behavioural responses of health professionals are affected by the different characteristics of financial incentives, which may be directed at networks of practices, individual practices, or specific health care professionals. Payments may be offered as a bonus or addition to usual earnings, or may be withheld if practices do not achieve desired outcomes. Payments may be prospective or retrospective and may be linked to fixed thresholds or individual patients.ends in PAHs and ED presentations among people with chronic disease.
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ItemPrimary health care-based programmes targeting potentially avoidable hospitalisations in vulnerable groups with chronic disease(Primary Health Care Research & Information Service, 2016)This report reviews outcomes of intervention programmes targeting reductions in potentially avoidable hospitalisations (PAHs) and/or avoidable Emergency Department presentations (ED presentations) among people with chronic disease. The focus is on the role of primary health care and where possible programmes targeting specific vulnerable populations, namely Indigenous Australians, rural and remote residents and those at socioeconomic disadvantage. This report also aimed to examine trends in PAHs and ED presentations among people with chronic disease.