Experts back calls for preventive action on chronic disease

Doug Hendrie

1/07/2019 3:50:00 PM

Australia’s tidal wave of chronic disease is growing, but GPs’ ability to deal with it is hamstrung by funding, experts say.

Pyramid of blocks
When there is no cure, the only answer is prevention.

Almost half of all Australians – 47.3% – are now living with a chronic disease.
That’s up from 42.2% just 10 years ago, according to the latest National Health Survey.
In the face of the growing numbers, Victoria University health policy expert Ben Harris has called for much greater investment in prevention and management.
‘About a third of chronic disease is preventable, yet we only spend 1.3% of our health budget on preventing disease,’ he told the ABC’s 7.30, which is this week running a four-part special on the health system. 
‘We need to do better with prevention and managing chronic disease. We need to start treating people, rather than treating diseases.’
Mr Harris told newsGP that chronic disease is a ‘community issue, not a hospital issue’.
‘GPs are asked to solve so many problems in healthcare with so few resources,’ he said.
‘GPs are asked to work on prevention, on management, on coordination for a whole range of tasks for chronic disease, yet the funding structure does not fully support GPs taking on each of those roles.
‘Fee-for-service is an old [funding] model designed to help GPs cure disease, not manage complex chronic conditions.
‘Australia’s healthcare system is very good, but a lot of it involves GPs needing to cross-subsidise within their practice or sacrifice income for quality care. A number of countries do chronic disease coordination better, generally through identifying patients at risk and providing wrap-around integrated care.’
Mr Harris predicts that the impact of chronic disease will only intensify, driven by issues like obesity and mental illness.
‘There is worse to come – and not just from ageing,’ he said.
‘More young Australians have more chronic diseases. The largest increases are in the working-age population. Mental health conditions are a very strong contributor, as is obesity.
‘Very few people go to hospital with chronic health conditions. Most are managed in the community and the burden falls on general practice. Health policy needs to recognise this.
‘GPs need to step up to help people manage their own health conditions, and they need to be supported to do so.’
The Federal Government announced a $448 million chronic disease funding model in this year’s budget, but restricted the longer consultations and services to people over the age of 70.
The RACGP welcomed the announcement, but also questioned whether the funding would be enough to realise the full benefit.
Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP that general practice is the ‘cornerstone’ of preventive health and chronic disease management.
‘The RACGP sets the agenda with its flagship publication, the Red Book, outlining the evidence-based recommendations for prevention across the lifespan. GPs are doing a remarkable job in prevention of disease and prevention of consequences of having a chronic disease,’ he said.
‘General practice has shifted from a focus on acute needs to add a focus on chronic disease management and prevention.
‘Recently, there has been a further shift towards the management of multimorbidity. GPs recognise that most patients with a chronic disease have more than one. The complexity of multimorbidity is why there needs to be a seismic shift in policy to recognise the value of generalists in our system and to recognise the value of personal continuity of care.
‘I see great potential to make a significant investment in general practice through payments for voluntary enrolment. I see great possibilities for general practice teams to become experts at social prescribing to manage isolation and to assist with patient-activation.
‘I see a future where the most valuable asset of a general practice is their high-quality database that can be used to streamline the right care to the right person at the right time.
‘As a profession we need to be very careful that our data is used for the right purposes, that our central role in primary and secondary prevention is recognised, funded and supported.
‘We need to be very careful that care does not get fragmented to multiple single-organ specialist providers and single-modality therapy providers. Generalism is the only way to manage multimorbidity to address the quadruple aim of good healthcare.’

Multi-drug-resistant-gonorrhoea-hero.jpgChief Medical Officer Professor Brendan Murphy said Australia is ‘quite high up in the shame scale internationally of obesity’.
Australia’s Chief Medical Officer Professor Brendan Murphy told the ABC that obesity represents the single biggest challenge for the country’s medical system.
‘I think it is fair to call it a crisis,’ he said. ‘We’re quite high up in the shame scale internationally of obesity – nearly a third of our population are obese and nearly two-thirds are overweight or obese.
‘That is a massive challenge for us that requires a very significant multi-faceted approach in terms of nutrition, exercise, and particularly attention to early childhood, in my view.
Dr Lara Roeske, Chair of the RACGP’s Specific Interests Faculty, told the ABC that managing the complexity of chronic disease was a challenge, and called for a Medicare item number for consultations lasting more than 40 minutes.
‘If you ask most GPs what their one big wish would be, it would be to be able to spend more time with their patients in a way that is appropriately supported and subsidised,’ she said.
‘Some of the issues with managing these conditions is they often last for months or years; they're not curable; they often involve a multi-pronged approach to management.’
Dr Roeske called for a greater focus on preventive health through early testing and lifestyle factors.
‘There is no item number for spending more than 40 minutes with our patient. We are pressed but, more importantly, patients are pressed. They are the ones that are really missing out,’ she said.

chronic disease general practice funding preventive care

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Satheeka kamaladasa   2/07/2019 7:44:19 AM

Please consider to include as a chronic condition so that we can enrol the patient in GPMP & TCA & refer them to dietitian Exercise physio etc.
But at present we cant do it as it is not mentioned under a chronic disease

Bernadette Dulawan   2/07/2019 9:46:19 AM

I totally agree with this article and this cry for the shift in addressing chronic diseases in our funding priorities. It's long overdue. Hope this brings change and soon. Thank you for articulating this so eloquently!

Chris D Hogan   2/07/2019 10:23:10 AM

* Chronic illnesses occur from both the failure of medical treatment & from our successes. Obesity is a failure but renal impairment from congenital renal disease is a success & there are many other conditions where people would otherwise have died without intervention. It is not all bad news.
* Multimorbidity is only managed by General Practice but it is not adequately supported by Guidelines. According to Prof Winzenberg there are over 400 Guidelines for single conditions, a handful for 2 co-existent morbidities but none for 3 or more multimorbidities. The only exception may be for the deprescribing guidelines.
* General practice would benefit from systematised coordinated research & data gathering
* Knowledge is power & our profession would benefit from a strengthened alliance between clinician practice & research