Key Program Outcomes

The Collaboratives program has resulted in key changes within Australian primary care and better health outcomes for patients with chronic disease, including:

• Improved patient care through better management of Diabetes and Coronary Heart Disease
• Increased best practice care through better use of information systems (both medical and business systems)
• Evolving roles among practice staff to better meet patient demand
• A cultural shift from individual patient care to population based care

The Improvements

To date, forty-three divisions and over 600 Australian general practices have achieved significant improvements through their involvement in the APCC Program. The following improvements in evidence based clinical measures have been recorded. Results are relative to baseline data and national aggregates of all core waves as of December 2007 data submission:

Coronary Heart Disease (CHD)

• 28% improvement in the percentage of patients with CHD recorded as being on aspirin medication

• 26% improvement in the percentage of patients with CHD recorded as being on a statin medication

• 52% improvement in the percentage of patients who have had a myocardial infarction in the last 12 months who are on a beta blocker medication

• 50% improvement in the percentage of patients with CHD whose last recorded blood pressure was below 140/90mmHg

• 45% improvement on the number of patients on the CHD register

Diabetes

• 97% improvement in the percentage of patients with HbA1c levels equal to or below 7%

• 132% improvement in the percentage of patients with diabetes whose cholesterol was recorded below 4mmol/L

• 101% improvement in the percentage of patients with blood pressure equal to or below 130/80mmHg

• 84% improvement in the percentage of patients who have had a SIP claimed for them

• 34% improvement on the number of patients on the diabetes register

Better Access

• 7% improvement in the percentage of patients seen by a GP on the day of their choice

• 35% improvement in the practice nurse 3rd available appointment

Diabetes

• The Number of patients on the diabetes register.

• % of patients with diabetes with a last recorded HbA1c of ≤ 7.0% within the previous 12 months

• Percentage of patients with diabetes with a last measured total cholesterol of ≤ 4 mmol/l with in the previous 12 months.

• % of patients with diabetes with a last recorded B P reading of ≤130/80 mm Hg within the previous 12 months

• % of patients with diabetes that have had Diabetes Service Incentive Payments claimed for them with in the last 12 months

Improved Access

• 90% of patients seen by the practice on the day of their choice

• The number of days until the GP’s 3rd available appointment

• The number of days until the Practice nurse’s 3rd available appointment

Secondary Prevention of Coronary Heart Disease

• % of patients with CHD on Aspirin

• % of patients with CHD who are on a Statin

• % of patients who have had an MI in past 12 months and who are on beta-blockers

• % of patients with CHD whose last recorded BP within the last 12 months <140/90 mmHg