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Abstract
As the number of people living with chronic conditions continues to rise, the burden on individuals, communities and health care payers increases too. The provision of high-quality chronic disease management programs in primary care has been identified as central to reducing the impact of chronic disease on patients and the health care system, yet many barriers to effective delivery exist. In 2014 Medibank sought to establish if a dedicated program – “CareFirst” – that supports and enhances usual chronic disease management in primary care could improve patient experience, self-management capability and quality of life, leading to improved disease control and reduced risk of hospitalisation.
This thesis is the evaluation of a pilot of the program conducted in south-east Queensland from October 2014 to April 2016 in partnership with six primary care clinics. It consists of a before and after study of the pilot, focusing on clinical and behavioural outcomes, to test if the program improved patient health status and self-management, leading to greater disease control. Three qualitative studies were also conducted to test the feasibility and acceptability of this novel program: examining the experiences of participating patients, the practice nurse delivering the program, and the general practitioners from intervention clinics.
Results from the before and after study found that from baseline to program completion (6 months) graduates saw positive trends across all indicators and significant improvements in a number of them. Results from the qualitative studies show that it was well-received by the participating patients, that the practice nurses delivering the program implemented it as intended, and that the decision makers in primary care – the GPs – accepted it as a feasible model of care.
Results from the CareFirst pilot were encouraging; the evaluation found clinically significant improvements and the qualitative studies demonstrated feasibility with strong acceptance from all stakeholders – the patients and primary care providers. CareFirst enabled general practitioners and health insurers to revolutionise the way chronic disease services were delivered to their patients. Based on these results, Medibank commenced the national rollout of the CareFirst Program in June 2016, with more than 3,500 patients enrolled to date.