Care planning and adherence to diabetes process guidelines: Medicare data analysis

Abstract

Objective. To test the association, in patients with a diagnosis of diabetes I and II, between having or not having a care plan, (i.e. General Practice Management Plans (GPMPs),Team Care Arrangements (TCAs)), and having the recommended number of biochemical checks according to the diabetes Annual Cycle of Care guideline. The checks comprised HbA1c, HDL cholesterol and urinary microalbumin. Methods. Chi-square analysis of retrospective group data obtained from the Medicare database (from ‘billing’ patterns only). Results. The creation of GPMPs was associated with general practitioners (GPs) requesting checks for HbA1c (59.7%), HDL cholesterol (36.9%) and microalbumin (50.8%) for diabetes patients in accordance with guideline recommendations. Although the introduction of multidisciplinary care via a TCA was associated with an increase in the frequency of HbA1c checks (61.3%) in accordance with the guidelines, there was a reduction in the number of HDL cholesterol (23.7%) and microalbumin (36.8%) checks. The group with no care plans had the lowest association with HbA1c (47.8%), HDL cholesterol (19.7%) and microalbumin (29.3%) checks that met guideline requirements for diabetes. Conclusions. The use of GPMPs showed strong association with increased testing of process measures that met guideline requirements for diabetes. Further research is needed to understand the value and benefits of TCAs in promoting adherence to diabetes guidelines. What is known about the topic? Research suggests that care planning is associated with increased adherence by GPs to some of the processes of care stipulated in diabetes guidelines. What does the paper add? This study examines Australia-wide data obtained from Medicare. The findings demonstrated strong association between care planning and the process measures examined in this study. In contrast to previous studies, multidisciplinary team involvement via a TCA appeared to be less important than a GPMP in promoting adherence to process measures. What are the implications for practitioners? GPs should continue to provide structure care to patients via General Practice Management Plans.