Module 4: Enhanced Primary Care

Learning Objectives

At the completion of this module participants will have:

  1.  improved understanding of eligibility criteria
  2.  improved understanding of the Enhanced Primary Care (EPC) Item numbers
  3.  the ability to assist in the completion of a GP Management Plan
  4.  improved knowledge of referral pathways
  5.  Knowledge of appropriate review intervals for EPC items
  6.  improved understanding of Medicare Claiming

Introduction

"Over three million Australians, or nearly one in seven, suffer from chronic disease and the problem is likely to be one of the great health challenges for Australia and the world in the 21st Century" (Australian General Practice Network 2007).

The Medicare Chronic Disease Management items were introduced in July 2005 to make it simpler for GPs to manage the health care of patients with chronic medical conditions, including those with complex needs requiring multidisciplinary care.

Eligibility

Enhanced primary Care is available for all patients suffering from a chronic, terminal and complex care condition.

The GP can be assisted by Practice Nurses(PN) Aboriginal Health Nurses (AHW) and other health professional in providing the chronic disease Management  (CDM) items

EPC Item Numbers

There are many EPC/CDM item numbers.  The following four Item no's are the EPC item no's most commonly used in the general practice setting by the GP and PN.

The following Item numbers can be claimed under the EPC program:

  • Item No 721 General Practice Management Plan(GPMP). 
  • Item No 723 Team Care Arrangements(TCA)
  • Item No  725 Review of GPMP
  • Item No 727 review of TCA

What is a GP Management Plan?

A GP Management Plan (GPMP) provides documentation of a patient's desired future health goals and strategies which help achieve health improvements.  The EPC powerpoint provides direction on how to complete a GPMP.

GPMP responsibilities of the practice nurse

In many practices the PN would see a patient in a clinic setting, where a GPMP would be drafted. Depending on the chronic disease, the nurse would progress
with the required physical assessment,  updating the health history, review of current pathology results, medication review, patient education needs and
support. The patient has a subsequent appointment with the GP who reviews and modifies the GPMP as required. The GPMP is printed and signed by the patient. 
A copy is required to be offered to the patient.

Chronic Disease Management Medicare items

A comprehensive reading of Chronic Disease Management Medicare items and commonly asked questions and the answers can be accessed from the Department of Health and Ageing.

GPMP, TCA GPMP Review and TCA Review templates

The type of format will differ per practice preference but the basic information required will be the same.  Use a template which best suits your practice.

Copies of some templates can be downloaded from AGPN

EPC Power point presentation

This powerpoint explains in a practical approach how Enhanced Primary Care Plans in the management of chronic conditions benefits patients

  • with complex needs.
  • promote collaboration and communication in team care arrangements (TCA)
  • clarify patient and provider eligibility

Reflection 

  • Think about the mix of patients who flowed through the practice today. 
  • Remember what they looked like and how they mobilised. 
  • Did they come alone or with someone to support them. 
  • Without knowing anything about them, Do a quick count in your head of  the people you merely suspect may have benefit from the EPC initiative and a GPMP. 
  • Are you surprised by the number you came to? 

Read the following case study and try to work out what CDM items could be claimed by the practice

Case Study:

Mr Wilkins is a 58 year old who has presented to the surgery.  Mr Wilkins does not regularly attend the surgery but has made an appointment today to organise repeat prescriptions and to have a check up.  Mr Wilkins has a medical history of Diabetes, Hypertension, Hypercholesterolaemia, Gout and COPD.  Mr Wilkins reports drinking more than 3 standard alcoholic drinks per day every day and recently quit cigarettes.  Mr Wilkins is  prescribed medication but reports he sometimes forgets to take it.  Mr Wilkins is currently prescribed Metformin 850, Atorvastatin 40mg, Aspirin 75mg, Ramipril 5mg and Allopurinal 300mg.

A review of blood pathology reports Mr Wilkins last results were HbA1c 8.4, Chol 6.3 and HDL 0.9.

On examination Mr Wilkins had a BMI of 31, a BP of 155/90 and poor peripheral pulses.