IMR Press / RCM / Volume 23 / Issue 9 / DOI: 10.31083/j.rcm2309318
Open Access Original Research
Are Medicare Funded Multidisciplinary Care Policies Being Claimed in accordance to Rehabilitation Needs in Patients with Stroke?
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1 Department of Medicine, Peninsula Clinical School, Central Clinical School, and National Centre for Healthy Ageing, Monash University, 3199 Frankston, Australia
2 Department of Neuroscience, Central Clinical School, Monash University, 3004 Melbourne, Australia
3 Occupational Therapy Department, Alfred Health, 3004 Melbourne, Australia
4 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, 3168 Clayton, Australia
5 Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3084 Heidelberg, Australia
6 Department of Public Health, School of Psychology and Public Health, La Trobe University, 3086 Bundoora, Australia
7 Department of Medicine, St Vincent’s Hospital, Melbourne Medical School, University of Melbourne, 3065 Fitzroy, Australia
*Correspondence: nadine.andrew@monash.edu (Nadine E Andrew)
These authors contributed equally.
Academic Editors: Jerome L. Fleg and Boyoung Joung
Rev. Cardiovasc. Med. 2022, 23(9), 318; https://doi.org/10.31083/j.rcm2309318
Submitted: 24 June 2022 | Revised: 18 August 2022 | Accepted: 26 August 2022 | Published: 14 September 2022
(This article belongs to the Special Issue Cardiovascular Health and Cerebrovascular Disorders)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Australian Primary Care Practitioners are incentivised through Medicare funded policies to provide chronic disease management and facilitate multidisciplinary care. Little is known about how these policies are claimed in the long-term management of stroke. The objective of this study was to describe the use of funded primary care policies for people with stroke by impairment status. Methods: Linked Australian Stroke Clinical Registry (2010–2014) and Medicare data from adults with 90–180 days post-stroke EQ-5D health status survey data and admitted to one of 26 participating Australian hospitals were analysed. Medicare item claims for Primary Care Practitioner led chronic disease management and multidisciplinary care coordination policies, during the 18 months following stroke are described. Registrants were classified into impairment groups using their EQ-5D dimension responses through Latent Class Analysis. Associations between impairment and use of relevant primary care policies were explored using multivariable regression. Results: 5432 registrants were included (median age 74 years, 44% female, 86% ischaemic), 39% had a chronic disease management claim and 39% a multidisciplinary care coordination claim. Three latent classes emerged representing minimal, moderate and severe impairment. Compared to minimal, those with severe impairment were least likely to receive chronic disease management (adjusted Odds Ratio (aOR): 0.61, 95% Confidence Interval (CI): 0.49, 0.75) but were most likely to receive multidisciplinary care coordination. Podiatry was the commonest allied health service prescribed, regardless of impairment. Conclusions: Less than half of people living with stroke had a claim for primary care initiated chronic disease management, with mixed access for those with severe impairments.

Keywords
stroke
primary health care
referral and consultation
epidemiology
secondary prevention
Figures
Fig. 1.
Funding
1072053/ National Health and Medical Research Council or the National Heart Foundation of Australia
1109426/ National Health and Medical Research Council or the National Heart Foundation of Australia
1042600/ National Health and Medical Research Council or the National Heart Foundation of Australia
1063761/ National Health and Medical Research Council or the National Heart Foundation of Australia
1154273/ National Health and Medical Research Council or the National Heart Foundation of Australia
102055/ National Heart Foundation of Australia
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