Wound care costs in general practice - a cross-sectional study.

BACKGROUND: The management of wounds presents a significant burden to healthcare services, consuming a large amount of resources. This study aimed to determine the cost of wound care in general practice by conducting an audit of current wound management practices. METHODS: Eighteen general practices collected data on wound care episodes over a period of 14 days during December 2011. RESULTS: For most of the 332 wound care episodes, the total cost was greater than the total income, resulting in a net loss to the practice. General practitioner care was the greatest contributor to the total cost and the overwhelming majority of income was from Medicare Benefits Schedule billing items. DISCUSSION: In most cases, general practices are not recouping the costs of wound care. There is a need for policy makers and general practices to review wound care funding and practices to ensure equitable best practice care is being provided.

Triggering change in diabetes care delivery in general practice: a qualitative evaluation approach using the clinical microsystem framework.

BACKGROUND: In 2008, the Sunshine Coast Division of General Practice (SCDGP) in Queensland, Australia initiated a highly successful Improved Diabetes Management (IDM) program with general practices in a regional area. The IDM program was evaluated against the 10 elements of a high functioning clinical microsystem framework as identified by Nelson et al. (2007) in order to determine key factors contributing to the successful adoption and uptake of the program in participating general practices. METHODS: The evaluation focussed on in-depth key informant interviews with 10 SCDGP staff and general practitioners (GPs) involved in the IDM program. A thematic analysis was undertaken and common emergent themes were reviewed against the 10 elements of high performing clinical microsystem. RESULTS: While all aspects of the clinical microsystem approach appeared effective in the design, implementation and adoption of the IDM program, several characteristics were crucial. The identification of champions of change in both the division and participating practices, the celebration of positive achievements and the use 'real data' from practices to demonstrate improved health outcomes for patients from the practice were instrumental in motivating participating GPs to both implement and sustain changes in their diabetes care delivery. CONCLUSION: In designing and redesigning health care, the clinical microsystems approach offers a pathway for the effective uptake of innovation in Australian primary health care; a means of integrating structure, process and outcomes of a care framework for reviewing improvements in the health care delivery process and could lead to improvements in patient health outcomes.