Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice

The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model’s feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients’ stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

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Self-management factors associated with quality of life among women with endometriosis: a cross-sectional Australian survey

Human Reproduction ◽

10.1093/humrep/deaa330 ◽

2020 ◽

Author(s):

Rebecca O’Hara ◽

Heather Rowe ◽

Jane Fisher

Keyword(s):

Quality Of Life ◽

Chronic Disease ◽

Disease Management ◽

Self Efficacy ◽

Chronic Disease Management ◽

Self Management ◽

Cross Sectional ◽

Female Population ◽

Management Factors

Abstract STUDY QUESTION What self-management factors are associated with quality of life among women with endometriosis? SUMMARY ANSWER Greater self-efficacy was associated with improved physical and mental quality of life. WHAT IS KNOWN ALREADY Women with endometriosis have an impaired quality of life compared to the general female population. However, most studies have investigated quality of life in a hospital or clinic setting rather than a community setting and the association between self-management factors and quality of life have not, to date, been investigated. STUDY DESIGN, SIZE, DURATION A cross-sectional, population-based online survey was performed, which was advertised through women’s, community and endometriosis-specific groups. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 620 women completed the survey for this study. Mental and physical quality of life was assessed using the standardized SF36v2 questionnaire. Self-management factors included self-efficacy, partners in health (active involvement in managing the condition) and performance of self-care activities. Treatment approaches included the use of hormonal treatment, pain medications and complementary therapies and whether the participant had a chronic disease management plan. Hierarchical regression analyses were used to examine whether self-management and treatment factors were associated with quality of life. MAIN RESULTS AND THE ROLE OF CHANCE Both physical and mental quality of life were significantly lower among women with endometriosis compared to the mean scores of the general Australian female population (P < 0.001). Physical quality of life was positively associated with income sufficiency (P < 0.001) and greater self-efficacy (P < 0.001), but negatively associated with age (P < 0.001), pain severity (P < 0.001), use of prescription medications (P < 0.001), having a chronic disease management plan (P < 0.05) and number of self-care activities (P < 0.05). Mental quality of life was positively associated with being older (P < 0.001), partnered (P < 0.001), having a university education (P < 0.05), increasing self-efficacy (P < 0.001) and higher partners in health scores (P < 0.001). LIMITATIONS, REASONS FOR CAUTION Results are derived from a cross-sectional study and can only be interpreted as associations not as causal relationships. The sample was more educated, more likely to speak English and be born in Australia than the general Australian female population of the same age, which may influence the generalizability of these results. WIDER IMPLICATIONS OF THE FINDINGS This study investigated a knowledge gap by investigating quality of life of women with endometriosis in a large community sample. Self-efficacy was significantly associated with both physical and mental quality of life. Supporting women with endometriosis to improve self-efficacy through a structured chronic disease management programme may lead to improvements in this aspect of wellbeing. STUDY FUNDING/COMPETING INTEREST(S) R.O. undertook this research as part of her PhD at Monash University, which was supported by an Australian Government Research Training Program Stipend. J.F. is the Finkel Professor of Global Public Health, which was supported by the Finkel Family Foundation. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER NA.

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Systematic review of the effects of chronic disease management on quality-of-life in people with chronic obstructive pulmonary disease

Respiratory Medicine ◽

10.1016/j.rmed.2007.07.017 ◽

2007 ◽

Vol 101 (11) ◽

pp. 2233-2239 ◽

Cited By ~ 31

Author(s):

A. Niesink ◽

J.C.A. Trappenburg ◽

G.H. de Weert-van Oene ◽

J.W.J. Lammers ◽

T.J.M. Verheij ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Chronic Disease ◽

Disease Management ◽

Pulmonary Disease ◽

Chronic Disease Management ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

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The feasibility, acceptability and sustainability of nurse-led chronic disease management in Australian general practice: The perspectives of key stakeholders

International Journal of Nursing Practice ◽

10.1111/ijn.12027 ◽

2013 ◽

Vol 19 (1) ◽

pp. 54-59 ◽

Cited By ~ 24

Author(s):

Desley G Hegney ◽

Elizabeth Patterson ◽

Diann S Eley ◽

Rosemary Mahomed ◽

Jacqui Young

Keyword(s):

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Key Stakeholders ◽

Australian General Practice

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A new political anatomy of the older body? An examination of approaches to illness in old age in primary care

Ageing and Society ◽

10.1017/s0144686x12000293 ◽

2012 ◽

Vol 33 (6) ◽

pp. 964-987 ◽

Cited By ~ 5

Author(s):

SUSAN PICKARD

Keyword(s):

Primary Care ◽

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Old Age ◽

Older Patients ◽

Chronic Disease Management ◽

Geriatric Medicine ◽

Evidence Based ◽

Practice Nurses

ABSTRACTThis paper examines the new approaches to older bodies found within primary care, with the purpose of determining whether they represent a significant disjunction from established approaches in geriatric medicine. A genealogical review of clinical approaches to certain conditions commonly found in old age is undertaken utilising (a) key texts of pioneering British geriatricians and (b) three editions of a key textbook of general practice, published between 1989 and 2009. The discourses and practices established by the Quality and Outcome Frameworks in England are then examined, focusing on evidence-based guidance for these same conditions. Following this excavation of written texts, empirical data are analysed, namely the accounts of general practitioners and practice nurses regarding application of the technologies associated with chronic disease management to older patients. Continuities and changes identified by these practitioners are explored in terms of three specific consequences, namely conceptualising and treatment of older bodies and interaction with patients. The paper's conclusion considers whether these changes are significant enough to warrant describing them as representative of an epistemic rupture or break in the way older bodies are perceived, both in medicine and also in society more generally, and thus of constituting a new political anatomy of the older body.

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Effectiveness of Chronic Disease Management Program in Improving the Quality of Life under National Health Insurance

International Journal of Recent Technology and Engineering - 2 ◽

10.35940/ijrte.b1054.0982s919 ◽

2019 ◽

Vol 8 (2S9) ◽

pp. 245-250

Keyword(s):

Quality Of Life ◽

Health Insurance ◽

Chronic Disease ◽

Disease Management ◽

Chronic Diseases ◽

National Health Insurance ◽

Disease Management Program ◽

Chronic Disease Management ◽

Management Program

Purpose: The Chronic Disease Management Program (Prolanis) implemented at Puskesmas with the concept of cost effective and efficient health services in the National Health Insurance (JKN). Prolanis intended for participants who suffer from chronic diseases to achieve optimal Quality of Life (QoL). Therefore, aims this study to assess the effectiveness of Prolanis services in improving the quality of life of JKN participants in Banyuasin District. Methodology: This study using a cross sectional design, data was taken in 2018. Population is people who suffer from chronic diseases (type 2 Diabetes Mellitus and Hypertension). Sample was pre-elderly dan elderly as Puskesmas visitors in Banyuasin District was chosen by proportional random sampling (n=250 people). Data collection used the WHOQOL-BREF questionnaire through direct interviews with respondents. Data analysis using bivariate and multivariate analysis. Main Findings: The respondents were most underage of 60 years (participants of 63.4% and non-participants of 74.1%). Most of respondents had moderate exercise habits (participants of 59.9% and non-participants of 51.9%), among others: walking, jogging, cycling, or other sports. Body Mass Index in normal category (participants of 62.0% and non-participants of 64.8%). It’s known that Prolanis participants (61.3%) and non-participants (53.7%) have majority perception of a good QoL. Respondents who are willing to become Prolanis participants are around 142 people (56.8%). Application: The Puskesmas can improve socialization and motivation for participants to use Prolanis services, and to increase the frequency of gymnastic club activities continuously so that there are many time choices. Novelty: Participants who used Prolanis services more often, will have a higher QoL score. Respondents who visited Prolanis services 3-4 times had a tendency to be 1.3 times more likely to have a good perception of QoL (RR:1.33; CI95%:0.71–2.49).

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Revenue effects of practice nurse-led care for chronic diseases

Australian Health Review ◽

10.1071/ah13171 ◽

2014 ◽

Vol 38 (4) ◽

pp. 363 ◽

Cited By ~ 2

Author(s):

Richard A. Iles ◽

Diann S. Eley ◽

Desley G. Hegney ◽

Elizabeth Patterson ◽

Jacqui Young ◽

...

Keyword(s):

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Cost Analysis ◽

Chronic Disease Management ◽

Practice Nurse ◽

Linear Regression Analysis ◽

Geographic Location ◽

Economic Feasibility ◽

General Practices

Objective To determine the economic feasibility in Australian general practices of using a practice nurse (PN)-led care model of chronic disease management. Methods A cost-analysis of item numbers from the Medicare Benefit Schedule (MBS) was performed in three Australian general practices, one urban, one regional 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 management of their condition over a period of 12 months. After the 12-month intervention, total MBS item charges were evaluated for patients managed 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 analysis 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 management, but the benefits from a financial perspective are less clear. What does this paper add? The cost-analysis of a PN-led model of chronic disease management in Australian general practice is reported, providing an indication of the financial 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.

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293 Improving the Quality of Dementia Care in General Practice: A Qualitative Study

Age and Ageing ◽

10.1093/ageing/afz102.64 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii1-iii16

Author(s):

Meghan Bourque ◽

Tony Foley

Keyword(s):

Primary Care ◽

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Community Services ◽

Dementia Care ◽

Community Based ◽

Data Set

Abstract Background The prevalence of dementia in Ireland is rising. General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for community-based care, emphasized by the Irish National Dementia Strategy (INDS). The INDS advocates a multidisciplinary, community-based approach to dementia care. However, there is a paucity of research exploring GPs’ views on dementia since publication of the INDS. The aim of the study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice from the perspective of Irish GPs. Methods Semi-structured interviews were conducted with GPs. GPs who completed a continuing professional development module in Cork on dementia in primary care were purposively recruited. Interviews were analyzed thematically. Analysis was iterative and ongoing with data collection. Results 12 (34.3%) GPs agreed to participate. 10 interviews have been conducted to-date. Participants were evenly distributed by sex (5 male, 5 female). Experience in General Practice varied (3-32 years). Most GPs practiced in mixed urban-rural settings (n=8) and had nursing home commitments (n=7). The average interview length was approximately 45 minutes. Three major themes emerged from the data set: factors promoting care in current practice; resistance to care; and recommendations to improve care. Continuity of care, early disease recognition, coding, audit, and coordinated care teams were recognized as factors promoting quality care. Time, funding, access to secondary care, and inadequate community resources hindered care. GPs emphasized the need for coordinated community services, GP education, review of the chronic disease management scheme for GPs, and service standardization in order to improve care. Conclusion GPs find dementia care to be a complex, challenging aspect of primary care. While education and training is advocated by GPs, service delivery also needs to be reconfigured. Dementia needs to be included under chronic disease management in Ireland and services must become standardized.

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