Australian Primary Health Care Reform and the Medical Home

Posted by on Sep 24, 2012 in Articles | 0 comments

Health care reform
This month, The Australian Governments (state and federal) released a report that details components of a National Primary Health Care Strategy.

Element 4 of this strategy details how a medical home can contribute to a system that is ‘Well-integrated, coordinated, and providing continuity of care, particularly for those with multiple, ongoing, and complex conditions’

An extract

The concepts of ‘medical home’ and ‘patient enrolment’

In terms of integrated and coordinated care, the concept of a ‘medical home’ or regular provider is increasingly recognised internationally as an important component of improving health care. The Commonwealth Fund 2007 survey found that 96% of Australian adults surveyed have a regular doctor or place of care (or a ‘medical home’).188 The Survey reported that for those Australians with a medical home, defined as having a ‘regular provider who knows you, is easy to contact and who coordinates your care’, 87% rated the care they received as ‘excellent’ or ‘very good’ compared with only 60% of those who do not have a ‘medical home’.189 It also found that Australian adults who have a regular provider were significantly more likely to have a written care plan, receive reminders for preventive/follow-up care, experience less medical errors and report that they receive excellent or very good care from their doctor.190

This survey-based measure of ‘loyalty’ or continuity of care is higher than relevant figures derived from Medicare data. From Medicare data, of the individuals who had more than one in-surgery consult, 47.8% (6.5 million) had all of their surgery consults with a single provider or in a single practice. The rate climbs to 84% if patients who visited only two practices or two providers are classified as ‘loyal’ but then declined as the number of surgery consultations for a patient increased: dropping below 50% by four surgery consultations, about 33% by 12 consultations and under 20% by 50 consultations.

Both the survey and MBS data suggest that a high proportion of Australians have either one or two ‘home’ providers of primary (medical) care; whether these correspond to the concept of a ‘medical home’ (eg in terms of a place that coordinates the patient’s care) is less clear.

While the ‘medical home’ concept can bring potential benefits to the whole population, it is particularly applicable in the management of chronic disease. In international experience, the ‘medical home’ is also coupled with some form of voluntary or compulsory patient enrolment. Internationally, enrolment for particular health conditions or populations is being used as a mechanism for improving the continuity, coordination and integration of care.

Establishing an ongoing relationship with a health service through enrolment or registration has potential advantages in terms of continuity of care. It can encompass oversight and coordination of care for an individual patient including responsibility for maintaining information about that individual and active engagement in transitions between care settings.

A voluntary registration arrangement is included as a component of the recently announced COAG Indigenous National Partnership. This arrangement does not limit an individual’s access to services from other providers but actively encourages an ongoing relationship between the practice and the patient.

yourHealth – Element 4: Well-integrated, coordinated, and providing continuity of care, particularly for those with multiple, ongoing, and complex conditions: “”

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