The feasibility, acceptability and cost-effectiveness of nurse-led models of chronic disease management in general practice

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The feasibility, acceptability and cost-effectiveness of nurse-led models of chronic disease management in the Australian environment The aim of this project is to address significant gaps in the evidence for a practice nurse-led model of the management of patients with chronic disease in general practice. Our research questions are: 1) is it feasible from a systems perspective i.e., the impact of the changes on the service delivery of chronic disease management through primary care, 2) is it acceptable to key stakeholders as well as to patients/carers i.e., will the necessary changes associated with this model of care develop productive partnerships between health care providers stakeholders and consumers; 3) is it cost-effective within the current regulatory environment and 4) does it have an impact on patient health/quality of life? The chronic diseases to be managed in this study are diabetes Type II and cardio-vascular disease (hypertension and ischemic heart disease). Objectives of the Project: The study will determine if: a) the employment of a practice nurse (PN) in general practice to manage the day to day care of patients (and their carers) with chronic disease is feasible within the general practice environment. Issues to be considered will be the design of the general practice environment, the number of patient consultations per day, descriptions of the scope of practice of the nurse (are there education and legislative changes required to the scope of practice?). b) nurse-led patient care, rather than GP led care, is acceptable to: (i) patients and their carers (ii) staff within the general practice , General Practitioners (GPs), Practice Managers, other PNs) c) it is cost-effective. (i) does the employment of nurses in this capacity increase the number of patients who can be seen within general practice? (ii) is there any impact on the number of patients requiring after hours care (in hospital emergency departments as well as by the practice)? (iii) are waiting lists to see a general practitioner reduced within the practice? (iv) Is the current EPC model for Chronic Disease Management Plans sufficient payment to the practice for the employment of a practice nurse or are other models more cost-effective? The study duration will be 3 years, 12 months of which will comprise the comparison of the two models of care in each of the three participating general practices. The general practices have been purposively selected by their willingness to participate, the distance they are from each other (thus ensuring that patients would not visit one or more of the other practices), their rural classification, they are computerised and employ a PN. The general practices are: • The remote practice is Myall Medical Centre, Dalby Queensland • The rural general practice is Koinonia located in Toowoomba, Queensland • The regional practice is Kingscliff Medical Centre in Kingscliff NSW. This program addresses policy implications associated with the of role chronic disease as a national health priority, the huge burden of chronic disease and the statistical evidence of its growth. Finding better ways to manage these diseases are necessary to GPs who face increasing case loads of patients. This project will inform policy to establish such a role and ultimately improve chronic disease care within primary practice.

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