Uptake of Medicare chronic disease management incentives - a study into service providers' perspectives.

BACKGROUND: Chronic disease is responsible for 80% of the burden of disease in Australia. The Australian Government Medicare Benefits Schedule (MBS) provides incentives through specific Medicare items to optimise chronic disease management (CDM), yet little is known about factors that influence their uptake. METHODS: Exploratory qualitative research was used, which incorporated focus groups and interviews with 26 staff from nine general practices in southeast Queensland, together with review of practice-specific data on CDM income. Content analysis of qualitative data was undertaken to identify barriers, enablers and service models associated with MBS CDM item uptake. Triangulation of methods and data sources facilitated confirmation of findings. RESULTS: Time pressures and unreliable MBS information were common barriers to uptake for general practitioners. Employing a nurse, team-based approaches, recall systems and using only selected MBS CDM item numbers were associated with best uptake. CONCLUSION: Improved systems within general practice and Medicare may increase the uptake of MBS CDM item numbers.

A is for aphorism - if 'a physician who treats himself has a fool for a patient' - are we all fools?

Sir William Osler was a great physician and medical educator and many of his wise teachings have survived the passage of time, including the counsel about self treatment - the title of this article.

Developing the guidelines for preventive care - two decades of experience.

BACKGROUND: The Royal Australian College of General Practitioners Guidelines for preventive activities in general practice (the 'red book') are now more than 20 years old. Therefore it is an important juncture to reflect on their appropriateness and implementation, and how they can be improved in future editions. OBJECTIVE: This review analyses the guidelines and their development against criteria identified by the AGREE collaboration to ensure the quality and applicability for use in Australian general practice. DISCUSSION: The 'red book' is widely accepted as supporting the provision of preventive care and is now a key element of the quality system in Australian general practice. This independent guideline has rigor, relevance and applicability to general practice. However, its impact on practice could be improved by broader consultation and by using a wider range of means for dissemination and implementation. This needs to be informed by more rigorous evaluation of its implementation and impact on practice.