Grattan report slams primary care

Ineffective management of heart disease, asthma, diabetes and other chronic illness costs the Australian health system more than $320 million each year in avoidable hospital admissions, says a new Grattan Institute report that the AMA has described as an “unfair attack”.

According to Chronic failure in primary care, at best the Australian primary care system provides only half the recommended care for many chronic conditions.

The report claims that only a quarter of the nearly one million Australians diagnosed with type 2 diabetes get the monitoring and treatment recommended for their condition.

“Each year there are more than a quarter of a million admissions to hospital for health problems that potentially could have been prevented,” says Grattan Health Program Fellow Hal Swerissen.

“Yet each year the government spends at least $1 billion on planning, coordinating and reviewing chronic disease management and encouraging good practice in primary care.”

The report finds that outcomes are much better where good quality primary care services are in place.

“Our primary care system is not working anywhere near as well as it should because the way we pay for and organise services goes against what we know works,’ says Professor Swerissen.

“The role of GPs is vital, but the focus must move away from fee-for-service payments for one-off visits.”

A broader payment for integrated team care would help to focus care on patients and long-term outcomes, it says, and Primary Health Networks should be given more responsibility for coordinating local primary care services.

The Australian Medical Association slammed the report.

Chair of the AMA Council of General Practice Dr Brian Morton says the Report paints an unduly pessimistic picture of the care that GPs are providing to patients with complex and chronic disease.

“The Report is a welcome contribution to the ongoing national discussion about how to best deal with the rapidly growing number of people suffering from complex and chronic conditions, but it is blatantly wrong for the Institute to blame GPs for any perceived failings in primary health care delivery,” Dr Morton says.

“The Grattan Report singles out diabetes care as being one area where Australia is performing poorly, but other data contradicts this.

“For example, hospital admission rates per 100,000 population for uncontrolled diabetes in Australia are among the best of the OECD countries at 7.5 – well under the UK at 23.9 and the OECD average of 50.3.”

Dr Morton highlighted the establishment of the Primary Health Care Reform Advisory Group to consider potential reforms to help improve care for patients with complex and chronic disease.

One of the AMA’s recommendations to the Group is the introduction of non-dispensing pharmacists in general practices to help improve medication management, particularly for patients with chronic disease.


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