Effects of the Medicare enhanced primary care program on primary care physician contact in the population of older Western Australians with chronic diseases

Abstract

Objective. Assess uptake of Medicare’s enhanced primary care (EPC) services in Western Australia (WA) in 2001 to 2006, evaluating effect of EPC services on the regularity of contact with general practitioners (GPs) in patients aged 65+ years. Method. Whole-population cohort study using linked routinely collected health service data from State and Federal health databases. Analyses include age-standardised rate of EPC services, odds of EPC utilisation relative to other GP services using logistic regression, and total GP service regularity pre- and post-implementation of the EPC program. Results. EPC services provided to WA seniors increased 345% 2001 to 2006, comprising an increasing proportion of the total GP services (1.1 to 3.6%). Uptake of EPC services accelerated abruptly after 2004 due to greater use of ‘care plans’. EPC services were associated with a history of chronic disease, especially type 2 diabetes (OR = 1.74, 95% CI 1.66–1.82). Regularity of total GP services was improved with any EPC service exposure, with greater improvement occurring in the presence of annual EPC service exposure. Conclusions. EPC item uptake responded favourably to item changes from Medicare Australia. Prior exposure to EPC items increased the regularity of GP services, an outcome inversely associated with chronic disease progression.