As a Santa Barbara Chiropractor I wonder how the chiropractors in Australia are taking the news that they may be included in these government imposed outcome measures?
Patients’ health a new test for GPs
GPs are likely to face a raft of performance targets that for the first time measure how well their patients do, rather than simply whether their fridge is keeping vaccines cold or if the practice has procedures to inform patients of test results.
The proposals mean general practices could be expected to show that patients on their books who have various chronic diseases are demonstrably healthier. One example would be to require that practices ensure blood sugar is kept at an acceptably low level in a set percentage of their diabetes patients. Another would be to ensure a set percentage of patients with heart disease have their blood pressure below a certain threshold, and are taking anti-clotting drugs that are shown to reduce heart attack risk. The plan has been devised by the not-for-profit company Australian General Practice Accreditation Ltd, one of the two agencies that send inspectors to GP surgeries to see if they meet the standards devised by the Royal Australian College of General Practitioners. The 34-page document outlining the idea says the impetus for the plan is “frustration with the current slow adoption of quality improvement in primary care”. It suggests extending accreditation requirements not simply to GP patient outcomes, but also to other health professions in primary care, such as nurses, physiotherapists, chiropractors and skin cancer clinics. However, the document also acknowledges the plan, which has been submitted to the federal Government’s primary healthcare reform body, is likely to prove “threatening to some professional associations and colleges”. The existing incarnation of GP accreditation was fiercely criticised by some doctors for undermining their autonomy after it was first introduced in 1997. While accreditation is voluntary, the take-up rate is now more than 90 per cent because becoming accredited makes practices eligible to apply for further federal government incentive payments, typically worth up to $45,000 a year. John Aloizos, chairman of the AGPAL subsidiary Quality in Practice, said GPs should back the plan as the alternative was likely to be a less palatable modelimposed by the federal Government. “The thing we have never measured before is (patient) outcomes, and this is the opportunity,” Dr Aloizos said. “Where it’s been tested — if you look at the results from programs in Australia, and in the UK, they have shown there have been improvements in … diabetes, cardiovascular disease and patient waiting times.” After a successful introduction, further targets could be introduced to extend the concept to most chronic conditions, including asthma, osteoporosis, cancers and chronic obstructive pulmonary disease. Last month’s interim report by the National Health and Hospitals Reform Commission recommended introducing payments for GPs and other primary healthcare workers to reward those whose patients recovered better, although the report did not spell out how outcomes should be measured. George Quittner, a GP from the Sydney suburb of Mosman, said the proposal was another example of “tick-box medicine”. “Whenever I go to a hospital now, nurses are never with the patients; they are at the nursing station filling in forms,” Dr Quittner said. “If you ask the patients, ‘when did the nurse last see you?’, they say they are all too busy. “I think a similar phenomenon will happen in medicine: doctors will get busier and busier filling in forms, but that won’t necessarily translate into better care,” he said.