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Chronic health an acute problem

More Australians can stay healthier and out of hospital – here’s how

The Conversation: March 7, 2016 6.06 am AEDT

Each year the Australian government spends at least A$1 billion on planning, coordinating and reviewing the care of people with chronic diseases, such as diabetes and heart disease, in general practice. Yet there are more than a quarter-of-a-million hospital admissions for health problems that potentially could have been prevented by better primary care for chronic disease. Australia’s health system was designed to deal with infectious disease, wars and accidents. But the most significant burden on the health system today is chronic disease.

High cost of chronic disease Three-quarters of Australians over the age of 65 have at least one chronic condition that puts them at risk of serious complications and premature death. Around 90% die from a chronic disease. Six chronic conditions:

  • heart disease,
  • oral health problems,
  • mental disorders,
  • musculoskeletal conditions (including arthritis),
  • respiratory disease (including asthma) and
  • diabetes –

account for about half of the total disease cost.

Most people with these conditions are seen by general practitioners in the primary care system. But we are failing to prevent and successfully manage chronic disease in primary care. For example, about a million Australians have diabetes. These people have a two-fold higher risk of dying from heart, kidney and peripheral vascular disease (the latter from reduced blood circulation) than the general population.

They need help managing diet, exercise, smoking and alcohol use.

They also need appropriate medication and regular monitoring. However, analysis done for our report showed that only about a fifth of people with diabetes who see a GP have their blood pressure, blood sugar and body mass recorded each year. Only about 20% of these patients reach recommended clinical targets. Often, they get little in the way of advice or support for self-management.

The story is similar for other major chronic diseases including heart disease and chronic respiratory disease. Often, less than half of people with chronic disease get the care that is recommended. This results in much poorer patient outcomes than could be achieved.

Ineffective management of chronic conditions in primary care leads to worse health outcomes and higher costs.

Potentially preventable hospital admissions are estimated to be 7% of all admissions, 9% of hospital bed days and cost up to A$2 billion each year. Even if we use the more realistic estimates developed for our report, the costs are A$322 million per year.

Chronic disease support is already well-funded

The Commonwealth has tried to fix the problem by introducing assessment, planning, coordination, team management and review payments for GPs to better manage chronic disease, including mental health. More than A$1.7 billion was spent on systems management, care planning and coordination for primary care in 2013-14. This included A$904 million for health assessment, management of chronic disease and mental health, and incentive payments for asthma and diabetes. Practices received A$210 million in practice incentive payments to support infrastructure development and better practice. An additional A$661 million was spent supporting GPs and primary care through regional primary care networks, Medicare Locals (now Primary Health Networks).

Prevention and management of chronic disease in primary care is not easy. It requires sustained effort by people with chronic conditions working in partnership with a team of health professionals. The role of GPs is vital. Care must be planned rather than reactive; it must focus on the patient, rather than on health professionals, and it must focus on outcomes. In Australia, the split in Commonwealth and state responsibilities has made good-quality prevention and care for chronic disease more difficult. The states are mainly responsible for public hospitals and the Commonwealth is responsible for GPs and primary care. As a result, the system for preventing and managing chronic disease is fragmented. Performance targets are largely absent. There is little agreement about local care pathways, which guide how patients should be treated. Funding incentives are poorly designed and there is only limited support for service innovation and improvement.

So whats the solution?

The focus of chronic disease funding needs to move away from a fee-for-service payment to doctors, towards a broader payment for clinics to practise integrated care. The evidence shows that a consistent approach to clinical care pathways for specific chronic diseases can make a real difference to outcomes.

Natural medicine has the knowledge and tools to assist those with chronic conditions to better manage their conditions.  Furthermore, if Governments would provide more support for and acknowledge the role that natural medicine has in the overall wellness of our nation, many of the above-listed chronic conditions could be avoided.