Does incentivising GPs to provide multidisciplinary care following stroke target those most in need: A linked data study?.

Abstract

Background: General Practitioners (GPs) are incentivised through Medicare funded Team Care Arrangements (TCAs) to provide multidisciplinary care. It is unknown whether these items are appropriately targeted among survivors of stroke. Aim(s): To describe, by impairment, the use of TCAs in survivors of stroke living in the community. Method(s): Data from the Australian Stroke Clinical Registry (AuSCR: 2010-2014, N=26 hospitals, five states) were linked with Medicare. Adults registrants who provided EQ-5D health status survey data between 90-180 days were included. Receipt of TCA items during the 18-month period following stroke were identified using Medicare data. Latent Class Analysis (LCA) was used to classify registrants based on their EQ-5D dimension responses (mobility, self-care, anxiety/depression, pain, usual activities). The relationships between LCA classes and TCAs were explored using multivariable logistic regression. Result(s): 5,432 AuSCR registrants were included (44% female, median age 74 years, 86% ischaemic). Of these, 34% received a TCA and 24% had an allied health claim (66% podiatry, 25% physiotherapy, others<5%). Most TCAs (86%) involved only one type of allied health professional. Registrants were classified into three latent classes defined as: minimal, moderate and severe impairment. Receipt of a TCA varied by class: mild (32%), moderate (40%), severe (25%). Compared with minimal impairment, the odds of receiving a TCA were greater for those in the moderate (aOR: 1.37, 95%CI: 1.21, 1.55), but lower for those in the severe impairment class (aOR: 0.75, 95%CI: 0.60, 0.94). Conclusion(s): While one in three survivors accessed TCAs for multidisciplinary care, rates were lower in those with more severe impairment. Greater uptake of these items could fill gaps in long-term care after stroke, especially for those who may benefit most.