Medicare-funded care plans save lives after stroke: Study

In Australia, it is estimated that more than 100 stroke events take place each day, with around 39,500 occurring in 2020 alone.
 
The chronic disease can result in preventable hospitalisations, disability and premature death.
 
But research published in The Lancet Regional Health Western Pacific this month, led by Associate Professor Nadine Andrew from Monash University, has found that chronic disease management plans in primary care have an important role to play in the long-term recovery and survival of patients.
 
The study included more than 12,000 participants with a median age of 70, identified through the Australian Stroke Clinical Registry from 42 hospitals in Victoria and Queensland, who were living in the community and had survived to 18 months following either a stroke or transient ischemic attack (TIA).
 
The findings revealed those who had a management plan in place with their general practice had a 26% lower mortality rate compared to those without a plan. The research also showed that those with a plan were more likely to be adherent with preventive medications, such as non-aspirin antithrombotic (83.4% vs 77.6%), lipid-lowering (87.8% vs 82.6%) and antihypertensive medication (86.3% vs 77.4%).
 
When it came to hospital presentations, however, there was an overall greater rate among those with a management plan, but the authors did note that emergency department (ED) presentation rates ‘did not differ’ when stratified by high vs low acuity.
 
‘When examined separately there was a 23% increase for ED presentations that did not result in an admission and a 15% increase for admissions,’ they wrote.
 
‘When examined further, there was a non-significant 10% increase in rates of unplanned admissions and a 21% increase in rates of planned admissions.’
 
Despite this, however, the authors concluded that the study provides a ‘strong case’ for the ongoing provision of Medicare-funded chronic disease management plans.
 
‘We provide evidence of survival benefits afforded by government policies that financially support primary care physicians to provide structured chronic disease management in the long-term management of stroke/TIA,’ they wrote.
 
While the benefits are clear, there is concern over low uptake, with just 45% of the study participants having a management plan in place following a stroke or TIA.
 
This is despite all stroke patients being eligible for a management plan funded under Medicare due to their elevated risk of subsequent cardiovascular events, and many of the risk factors being modifiable – from high blood pressure, insufficient physical activity, overweight and obesity to tobacco smoking.
 
To improve uptake, the authors noted that there is a clear need for a strategic approach.
 
‘[These strategies] could include: greater financial incentives and mandates, education for patients and healthcare professionals, and ongoing population monitoring involving audit and feedback,’ they suggested.
 
‘Future research is needed to understand nuances associated with uptake from both a provider and patient perspective.’
 
The Australian government has invested in chronic disease management policies within primary care through Medicare-funded financial incentives since 1999, with primary care physicians eligible to claim an additional amount on top of a prolonged standard consultation fee.
 
GPs can access a range of up-to-date evidence-based resources for chronic disease management on the RACGP website.
 
Further information about secondary prevention after stroke or TIA is available on the Stroke Foundation website.
 
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chronic disease chronic disease management plan Medicare primary care rehabilitation stroke