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.

Management of skin cancer in Australia--a comparison of general practice and skin cancer clinics.

BACKGROUND: Skin cancer is common in Australia and its increasing incidence has been matched by an increase in specifically focused skin cancer clinics staffed by general practitioners. This study compares the management of skin cancer in general practice with that of skin cancer clinic networks. METHODS: Analysis of billing data relating to management of skin cancer from 1 July 2005 to 30 June 2006 in three Queensland general practices (metropolitan, provincial, and rural) representing 23 100 patients and 23 doctors. As far as possible, methods were matched to those used in two published studies of skin cancer clinics. RESULTS: Of the 1417 skin cancers: 31 melanomas and 1361 nonmelanoma skin cancers (NMSC) were treated by excision, and 25 NMSC were treated nonsurgically. The biopsy to treatment ratio in general practice was 0.7 and the number needed to treat (NNT) was 39, compared with 3.1 and 29 in one skin cancer clinic network and 0.5 and 24 in the other. Eighty-seven percent of skin cancer excisions were closed by primary repair and 54% of all excised lesions were malignant, compared with 42 and 60% in one network and 76 and 46% in the other, respectively. DISCUSSION: The benign to malignant excision rate was similar in general practice and the skin cancer clinic networks, but one network reported very different rates of biopsy and complex wound closure. This raises questions as to whether outcomes are improved by these measures. These results demonstrate the usefulness of three billing data outcome measures in comparing activity in different clinical settings. However, the billing based NNT may not be a useful measure.