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Objectives: This study explored publicly funded health system and patient expenditure in the post-acute phase following discharge from inpatient acquired brain injury (ABI) or spinal cord injury (SCI) rehabilitation. The secondary aim was to explore sociodemographic and injury characteristics associated with high costs. Methods: This was a prospective cohort study. 153 patients (ABI: n = 85; SCI: n = 68) who consented to the use of their Medicare data were recruited between March 2017 and March 2018, at the point of discharge from ABI or SCI specialist rehabilitation units. The main outcome measure involved linkage of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data for the 12 months following discharge from rehabilitation. Bayesian penalised regression was used to determine characteristics associated with high costs. Results: The median number of MBS items used in the 12 months after discharge was 33 (IQR: 21–52). General practitioners and allied health services were accessed by 100% and 41% of the cohort, respectively. The median MBS system cost (in Australian dollars) was $2006 (IQR: $162–$3090). Almost half (46%) of the participants had no MBS patient expenditure. The median PBS system cost was $541 (IQR: $62–$1574). For people with ABI, having a traumatic injury or one comorbidity was associated with lower PBS system costs by on average $119 and $134, respectively. We also found that hospitalisation in ABI was associated with higher PBS system costs, by on average $669. Conclusion: There was evidence of high and variable MBS and PBS costs, raising concerns about financial hardship. Future research should focus on identifying any unmet service and prescription needs in the post-acute rehabilitation phase for these populations. What is known about the topic? Acquired brain injury and spinal cord injury incur high long-term health costs, yet little is known about Medicare service use and costs in the early post-acute phase. What does this paper add? This study provides insight into service use and the burden of injury on Medicare Benefits Schedule and Pharmaceutical Benefits Scheme systems in the 12 months after hospital discharge. High and variable system and patient expenditure are most notable. What are the implications? Highly variable patient costs raise concerns about the access and affordability of sufficient healthcare services in the post-acute rehabilitation period. [ABSTRACT FROM AUTHOR]

Background: Health system reform is directed towards better management of diabetes. However, change can be difficult, and patients’ perspectives are a key aspect of implementing change. Objective: This study investigated patients’ perceptions and experiences of type 2 diabetes (T2DM), self‐care and engagement with GP‐led integrated diabetes care. Design: Qualitative interviews were conducted with purposively selected patients with T2DM following their initial medical appointment in the new model of care. Normalization process theory was used to orientate the thematic analysis, to explain the work of implementing change. Setting: Two specialist GP‐based complex diabetes services in primary care in Brisbane, Australia. Participants: Intervention group patients (n = 30) in a randomized controlled trial to evaluate a model of GP‐led integrated care for complex T2DM. Main outcome measures: Participants’ experiences and perceptions of diabetes management and a GP‐led model of care. Results: Three themes were identified: sensibility of change, ‘diabetic life’ and diabetes care alliance. The imperative of change made sense, but some participants experienced dissonance between this rational view and their lived reality. Diabetes invaded life, revealing incongruities between participants’ values and living with diabetes. They appreciated a flexible and personalized approach to care. Discussion: Participants responded to advice in ways that seemed rational within the complexities of their life context. Their diabetes partnerships with health professionals coupled providers’ biomedical expertise with patients’ contextual expertise. Conclusions: Learning to manage relationships with various health professionals adds to patients’ diabetes‐related work. Providers need to adopt a flexible, interactive approach and foster trust, to enable better diabetes care. [ABSTRACT FROM AUTHOR]

The article presents a study which investigated the views of primary care patients of Medicare-funded team care in chronic disease management (CDM) in Australia. The researchers detail the study design, participants and setting, data collection procedure and outcomes. It implies that patients are likely to engage with a structured team care approach to CDM driven by personal obligation and sufficient financial incentive.

Background A new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner (GP) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting. This study evaluates the health and clinical benefits of the new model of care, assesses the acceptability of the model to patients, GPs and other health professionals, and examines the cost-effectiveness of the model. Methods and design The study is an open, non-inferiority randomised controlled trial with data collected at baseline, 6 and 12 months. Participants are identified from new patients on hospital-based diabetes outpatient clinic waiting lists and new GP referrals. Eligible consenting patients are randomised to either a community practice site (intervention) or a hospital site (usual care). In the intervention model, medical care is led by a GP Clinical Fellow in partnership with an Endocrinologist. Quantitative measures include clinical indicators with HbA1c as the primary outcome; patient-reported outcomes include health-related quality of life, mental health and satisfaction with care. Qualitative methods will be used to explore the perspectives and experiences of patients and providers regarding the new model of care. An economic evaluation will also be undertaken. Discussion This model of care seeks to improve the quality and safety of healthcare at the interface between the hospital and primary care sectors for patients with complex diabetes. The study will provide empirical evidence about the impact of the model of care on health outcomes, patient and clinician satisfaction, as well as any economic impacts. Trial registration Clinical Trials Registry Number: ACTRN12612000380897 [ABSTRACT FROM AUTHOR]

Aim: Uptake of Medicare-funded chronic disease management items has increased exponentially since the programme commenced in 2004. We aim to report on national utilisation of the five most referred of 13 allied health services and to examine patient uptake rates. Methods: Annual statistics generated from national Medicare billing data from January 2010 to December 2010 were extracted from the Medicare public database and compared by profession, state and per capita population. Results: The five most utilised individual services were: (in decreasing order) podiatry, physiotherapy, dietetics, chiropractic and speech pathology. They provided 94% of all allied health consultations nationally, on referral from general practitioners. Per capita utilisation revealed wide variation in uptake by state and territory; some states had far less services than the national average. Patterns of referral instanced by age range and gender of clientele differed between professions. Most dietetics clients were middle aged (45-74 years) and this fits with expectations of chronic disease incidence. There was inequity of access to group services for the management of type 2 diabetes, with most services (85%) provided in South Australia and New South Wales. Conclusion: Dietetics providers have maintained and improved their referral rate and continue to be the third most utilised Medicare chronic disease management allied health service. Six years into the programme, further exploration is warranted to understand the reasons for wide variation in rates of patient uptake for the service provider professions. [ABSTRACT FROM AUTHOR]

Objective. To evaluate new pathways to access allied health services introduced by the Enhanced Primary Care/Chronic Disease Management (EPC/CDM) initiative that may both increase or decrease equity to and efficiency in access. Design. A qualitative study consisting of semi-structured in-depth interviews with a purposively selected group of allied health practitioners. Participants and setting. Allied health practitioners in private practice in Queensland, Australia, from physiotherapy, occupational therapy, speech pathology, and exercise physiology backgrounds (n= 15). Main outcome measures. Interviews focused upon several issues including how referrals are made under the EPC/ CDM initiative and what happens for patients once their five allotted sessions are expended. Results. The EPC/CDM initiative appeared to address two key barriers of access to allied health services - costs to patient of access and patient awareness of benefits. However, gap payments may still be deterring economically disadvantaged patients from attending. Discussion. The EPC/CDM initiative is increasing access to allied health services for people with chronic diseases. However, it is evident that this initiative may still not be meeting the needs of those most disadvantaged economically, and may lead to duplication of efforts by allied health practitioners when patients move between private and public health care sectors. [ABSTRACT FROM AUTHOR]

Participation of allied health professionals (AHP) in the Enhanced Primary Care (EPC) program is increasing. However, access to allied health services is strictly delineated under the EPC program and AHP face unique practice realities in providing care to patients with chronic conditions. This paper examines the discretionary practices adopted by AHP in response to the realities at the policy-practice interface and situates the discussion within a description of their experiences with EPC. Semistructured telephone interviews were conducted with a purposive sample of fifteen AHP. Participants were selected from a larger cohort who responded to a questionnaire about EPC. The EPC program was perceived as a positive start, although some aspects were problematic. Participants reported that the restriction on the number of subsidised sessions was not conducive to providing a good allied health service to patients with complex care needs and remuneration was not commensurate with the nature and scope of treatment required. The AHP in this study spoke of the dilemma of wanting to assist patients but at the same time to operate a financially viable business. Moreover, their experience was that multidisciplinary team care was implied rather than reality. Abbreviated care practices, reasonable solutions for access, and entrepreneurial practices were strategies used to manage the policy-practice tensions. [ABSTRACT FROM AUTHOR]

Co-creation (or co-design) represents the highest form of stakeholder engagement, but it can be infeasible to co-create with all stakeholders through all stages of a research project. The choice of stakeholders for co-design will depend on the study purpose and context of change. For this deprescribing pilot study, general practitioners were recognised as a critical gateway for co-creation, with patients' perspectives of the deprescribing process to be assessed in the evaluation of the pilot. [ABSTRACT FROM AUTHOR]