Patients in a trial were given longer, priority appointments with their preferred GP.
Supplementing fee-for-service payments with incentives to provide prioritised care, longer appointments and proactive hospital visit follow-up to patients at higher risk of poor outcomes “paid dividends”, says experts.
Researchers at Flinders University have published a paper in BMC Primary Care on qualitative interview data on patient and professional perception of a year-long randomised control trial.
The trial compared a general practice intervention, which encouraged continuity of care, longer appointments and GP hospital follow-ups, to standard care for patients identified as being at high risk of poor health outcomes.
The paper acknowledges these would be “difficult to sustain financially” outside the trial context.
“One very interesting thing that emerged from the interviews was that many GPs and patients didn’t view the intervention as providing treatments that were markedly different to what had been provided before the trial,” Professor Richard Reed, head of general practice at Flinders University and co-author on the paper, said in a statement.
“It wasn’t as if we were testing a new wonder drug,” he said.
“Rather the intervention supported a ‘slow medicine’ approach where GPs were able to provide comprehensive and unhurried whole-person care.
“This approach appears to have paid dividends, particularly for our older patients, where the intervention was associated with a reduction in emergency department presentations and hospital admissions.”
GPs were asked to identify patients “who they believed were at risk of poor health outcomes and who may potentially benefit from the intervention” from a list of patients who were under 18, 18 to 64 with two or more chronic diseases or over 65.
In total, 1044 patients were included in the study, which was conducted in metropolitan Adelaide across 20 practices and involved 92 GPs.
After the study, 41 patients and 45 staff involved in the study, such as practice managers, GPs and practice nurses, were interviewed to ascertain whether the intervention “improved general practice services, reduced hospital admissions and finally whether they believed the intervention would be sustainable after the trial had completed”.
“Practice staff expressed a general desire to continue to provide the intervention after the trial completed but they also indicated that changes they had made to operationalise the intervention in their practice, such as reserving appointments for trial patients to facilitate continuity of care, would be difficult to sustain financially when the significant trial payments ceased,” says the paper.
Speaking to The Medical Republic, the study’s manager Leigh Roeger said the main takeaway from the interviews was that “patients and practice staff appreciated the intervention”.
“Patients appreciated the improved access they could get to their GP,” he added.
“By and large, patients are true believers in the continuity of care: they’d like to see their regular GP when they can.”
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Patients in the intervention group were enrolled to a preferred GP, who would either schedule regular appointments or block out time to provide priority appointments to intervention patients, to allow for longer appointments and limit wait time.
According to Mr Roeger, longer appointments meant that patients felt like they had time to discuss all their health concerns and reduced strain on carers, which was particularly important for older patients.
Senior research fellow Dr Sara Javanparast, who conducted the interviews, concurred, adding that overall patients were appreciative of the being prioretised for urgent appointments and GPs felt it allowed preventative care.
Intervention patients were also followed-up within seven days of any ED visit or hospital stay to assess whether a face-to-face appointment was necessary, which was appreciated by patients, said Mr Roeger.
He added that the hospital-GP handover could be improved by simplified discharge summaries and clearer advice to patients on letting their GP know about hospital visits.
The trial, Flinders QUEST, was funded by the RACGP and the federal government.
Practices received $10,000 to cover administration costs and $1000 per enrolled patient on the intervention arm.
Mr Roeger said that while it may not be feasible for all patients, “reducing the complete dominance of the fee-for-service approach led to benefits both for patients and for practices”.
He added that, in the group’s previous paper outlining the quantitative results of the study, while the intervention did not provide a cost-effective way to improve quality of life overall, it was found to be cost-effective for adults over 65.
But a study of the intervention targeted particularly at this patient group would be needed to ensure the results were 100% true.
