The benefits of a care plan in general practice are clear, but uptake remains low, says new research.
General practice chronic disease management plans are effective following stroke, but only 45% of eligible patients are enrolled in one, according to new Australian research.
The study, published in The Lancet Regional Health Western Pacific, linked patients from the Australian Stroke Clinical Registry from 42 hospitals in Victoria and Queensland with state and national hospital, primary care, pharmaceutical, aged care, and death datasets. Eligible participants were living in the community, not receiving palliative care and had survived 18 months after a stroke or TIA. The comparison was a Medicare claim for policy-supported chronic disease management, 7-18 months following stroke/TIA versus usual care.
Of the 12,368 participants, just 45% had a chronic disease management claim. But the benefits were clear.
Those with a management plan showed a 26% lower mortality rate compared to those without one. They were also about 20% more likely to be adherent with preventive (anti-thrombotics and lipid-lowering) medications.
The researchers, led by Associate Professor Nadine Andrew, a senior research fellow at Monash University, wrote that the low percentage of stroke patients with a plan was similar to other chronic conditions such as chronic lung disease (49%) and heart disease (47%).
“Despite the survival benefits, less than half of our cohort had a chronic disease management claim,” Andrew et al. wrote. “As all people who suffer a stroke/TIA have an elevated risk of subsequent cardiovascular events, all are eligible for these plans.
“Strategies to improve uptake at the primary care level are needed and could include: greater financial incentives and mandates, education for patients and healthcare professionals, and ongoing population monitoring involving audit and feedback.
“Future research is needed to understand nuances associated with uptake from both a provider and patient perspective.”
Impacts on hospital presentations were described as “variable” by the authors.
“There was an overall 17% greater rate of presenting to the hospital (ED presentations and admissions) in those with a chronic disease management claim compared to those without,” Andrew et al wrote.
“When examined separately there was a 23% increase for ED presentations that did not result in an admission and a 15% increase for admissions. When examined further, there was a non-significant 10% increase in rates of unplanned admissions and a 21% increase in rates of planned admissions. ED presentation rates did not differ when stratified by high vs low acuity. Hospital presentation rates due to cardiovascular disease, chest pain/collapse and abnormal findings were greater in those with a chronic disease management claim compared to those without.”
Andrew et al concluded that their findings provided “a strong case for the ongoing provision of these plans within a universal healthcare system, despite an observed increase in overall hospital presentations”.
