Mackay Division
of General
Practice Ltd
ABN: 21 062 930 385

43 Evans Avenue
North Mackay
Queensland
4740
Australia



Telephone
(07) 4953 4491

Facsimile
(07) 4953 4681

International Telephone
617 4953 4491

© 2008
Mackay Division
of General Practice

Privacy Statement

CHRONIC DISEASE MANAGEMENT

Chronic Disease Management (CDM) in General Practice involves appropriate prevention, early identification and best practice management strategies. The aim of our diabetes program at the division is to support GPs and general practice staff in all areas of their diabetes management, provide early detection of diabetes and prevention of complications.

ON THIS PAGE: ASTHMA | DIABETES | MENTAL HEALTH | LIFESCRIPTS

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ASTHMA

MDGP supports general practice to facilitate patient access to optimal Asthma care and delivers relevant continuing education to GPs and Practice Nurses.
Asthma Management Handbook is the current management tool for general practice.

Asthma Resources

Asthma Management Handbook

The current guide for Asthma Care is the Asthma Cycle of Care. The CDM Program Officer should be familiar with this guide.

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ASTHMA CYCLE OF CARE

Completing the Asthma Cycle of Care: A guide for General Practitioners

The Asthma Cycle of Care has replaced the Asthma 3+ Visit Plan. This guide provides information on how to complete the Asthma

Cycle of Care and claim the Medicare Benefits Schedule fee for an asthma specific item. An Asthma Cycle of Care includes at least two asthma related consultations within 12 months for a patient with moderate to severe asthma noting that the review visit must be planned. To complete an Asthma Cycle of Care you must:

1. Document diagnosis and assessment of asthma severity and level of asthma control

Moderate to severe asthma or a poor level of asthma control can be assumed for patients who:

• have symptoms on most days, OR
• use regular preventer medications, OR
• use a bronchodilator at least 3 times per week, OR
• have experienced acute exacerbations leading to hospital admission or attendance

Spirometry is testing and should be used for both diagnosis and assessment of severity. Most adults and children over seven years old can perform spirometry. When diagnosing asthma, Peak Expiratory Flow (PEF) Measurement is not a substitute for spirometry. When spirometry has been performed, the results should be documented in the patient’s medical record and/or the print out of results attached. Consider referral to a respiratory laboratory for spirometry if you are unable to perform it in your practice. preferred for diagnostic

2. Review the patient’s use of, and access to, asthma related medication and devices

To achieve the best possible asthma control with the lowest effective medication dose and minimum side effects, use of asthma related medications and devices should be regularly reviewed. Long-term adjustment of asthma maintenance medication needs to be tailored to each patient’s individual condition. Step down of medications should generally be considered 6–12 weeks after good control has been achieved. The step down of medications can be monitored by the frequency of symptoms, the use of reliever medication and objective measurement of lung function (preferably by spirometry).

3. Provide a written asthma action plan (or documented alternative if the patient is unable to use a written action plan)

Severe or life threatening asthma attacks are more likely to occur in patients
with inadequate medical supervision.

An individualized written asthma action plan should be developed so that a person with asthma can recognise deterioration and respond appropriately. Action plans can be based on symptoms and/or peak flow measurements.

Good asthma control can be defined as having:

• minimal symptoms during day and night
• minimal need for reliever medication
  
• no exacerbations
  
• no limitation of physical activity

Deterioration can be recognised by:

• increasing frequency or severity of symptoms, especially waking at night
• increasing use of reliever medication
• failure of medication to completely relieve symptoms
• falling peak flow and/or increasing peak flow variability

4. Provide asthma self management education

Studies have shown that asthma self-management education will provide people with asthma with the knowledge and skills to better control their asthma, resulting in fewer emergency attendances at the doctor or hospital. To meet the requirements of the Asthma Cycle of Care you must ensure that your patient has received self-management education. You may also wish to involve other health care providers such as nurses, asthma educators and pharmacists. For a patient with co-morbidities or complex needs you may consider using Team Care Arrangements (TCA) under the MBS (see below).

5. Review the written or documented asthma action plan

The final requirement before you can complete the Asthma Cycle of Care is that you review the patient’s asthma control and ongoing management as well as their written asthma action plan. This involves a complete review of asthma symptoms, lung function and response to treatment, medications and dosages and peak flow measurements (if appropriate).

For more detailed information regarding asthma diagnosis, assessment and best practice management refer to the National Asthma
Council’s website at www.NationalAsthma.org.au or call the NAC’s information line on 1800 032 495.

It is important to recall patients for regular assessment so that:

1. symptoms and peak flow charts can be reviewed
2. patient-initiated changes to therapy can be reviewed
3. inhaler technique can be checked
4. education and adherence to treatment plans can be reinforced
5. asthma action plans can be reviewed and updated (medications and dosages)
6. trigger factors and strategies for trigger avoidance can be reviewed
7. lung function can be objectively assessed by spirometry

A person with moderate to severe asthma should be able to:

• monitor their asthma using either symptoms or peak flow measurements
• use their written asthma action plan to· prevent and/or manage symptoms
• understand the triggers for their asthma and how to avoid them
• use medications and devices appropriately
• regularly review their asthma with their GP

Claiming your Asthma Service Incentive Payment (SIP)

You must meet the Asthma Cycle of Care requirements in a minimum of two visits (within a 12 month period). All visits should be billed under the normal attendance items with the exception of the visit that completes the Asthma Cycle of Care. When you have completed an Asthma Cycle of Care you may claim using the appropriate Medicare item numbers listed below:

Further information on this incentive is available from the PIP enquiry line on 1800 222 032 or www.medicareaustralia.gov.au/pip and in the Medicare Benefits Schedule Book.

GENERAL PRACTITIONER ATTENDANCE

Level	Type of Consultation	Item No -VR
B	Surgery consultation	2546
B	Out of Surgery Consultation	2547
C	Surgery consultation	2552
C	Out of Surgery Consultation	2553
D	Surgery consultation	2558
D	Out of Surgery Consultation	2559

OTHER NON-REFERRED ATTENDANCES (Non VR)

Surgery Consultations	Item
Standard Consulatation	2664
Long Consultation	2666
Prolonged Consultation	2668
Out-of-Surgery Consultations	Item
Standard Consultation	2673
Long Consultation	2675
Prolonged Consultation	2677

Alternative asthma care using MBS Chronic Disease Management items

The Chronic Disease Management (CDM) items provide an alternative funding mechanism to the SIPs for providing best practice care of patients with chronic conditions, including patients with asthma. For patients with asthma alone a GP should choose to use either GP managed care through the CDM items (GP Management Plan—GPMP), or provide an Asthma Cycle of Care, but not both services for the same patient as the work involved in both services overlaps (these items should not both be claimed in the same twelve months). For patients with asthma and complex needs requiring care from a multidisciplinary team, a GP may provide team-based care using the CDM items (for most patients this means a GPMP and a Team Care Arrangements—TCA), and the Asthma Cycle of Care. A CDM review item and an Asthma Cycle of Care should not be claimed within three months of each other as the work involved overlaps. More detailed information on the CDM items is available from Medicare Australia on 132 150 or in the Medicare Benefits Schedule Book.

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DIABETES

The Division supports general practice to facilitate patient access to optimal Diabetes care and delivers relevant continuing education to Practice Nurses and GPs. The aim of the division is to support GPs and general practice staff to further develop general practice in all areas of their diabetes management, provide early detection of diabetes and prevention of complications.

The current guide for Diabetes Care is the Diabetes Annual Cycle of care. The CDM Program Officer should be familiar with this guide.

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DIABETES ANNUAL CYCLE OF CARE

Diabetes Initiative Overview

1. Sign up practice for one-off 'sign-on' payment ($1.00 per SWPE or approximately $1000 per fulltime GP)

2. Set up Register of all known patients with diabetes

3. Identify from register patients who need specific diabetes care

4. Develop a recall system

5. Complete an annual Cycle of Care for patients with Diabetes Mellitus (see table below)

6. Use standard item numbers for consultations until completion of Diabetes Annual Cycle of Care

7. Claim MBS item 2517 or 2521 or 2525 at final consultation to trigger SIP ($40 payable to the GP once per year per patient)

An additional PIP outcomes payment for practices that complete annual cycle of care for 20% of all patients who have received a HBA1C test

Claiming the new Diabetes MBS item numbers – In Surgery Fees

Level	Consult Length	Item No - VR	Schedule Fee
B	<20mins	2517	$30.85 + SIP of $40.00
C	20 – 39 mins	2521	$58.55 + SIP of $40.00
D	>39mins	2525	$86.20 + SIP of $40.00

Minimum Requirements for Annual Cycle of Care for Diabetes Mellitus

Procedure	Recommended frequency
Measure weight and height and calculate BMI	At least every 6 months
Measure blood pressure	At least every 6 months
Examine feet	At least every 6 months
Assess diabetes control by measuring HbA1c	At least every 12 months
Measure total cholesterol, triglycerides, HDL	At least every 12 months
Test for microalbuminuria	At least every 12 months
Conduct a comprehensive eye examination	At least every 2 years
Provide self-care education	Patient education regarding diabetes management
Review diet	Reinforce information about appropriate dietary choices
Review levels of physical	Reinforce information about appropriate levels of physical activity
Check smoking status	Encourage cessation of smoking if relevant

Practice Incentives for Diabetes

The CDI is funded by the Federal Government and the General Practice Memorandum of Understanding Group. It consists of three components:

1. Patient Register and Recall/Reminder System

A one off sign on payment is available to practices of $1.00 per Standardised whole patient equivalent (SWPE) or around $1,000 per FTE GP. Payment is made quarterly.

2. Service Incentive Payment (SIP-Diabetes)

A payment of $40 is available to providers, for completion of an annual cycle of care per patient with Diabetes. The care guidelines have been set as minimum requirements.

3. Outcomes Component

If your practice has at least 2% of all patients (SWPE) in the practice diagnosed with diabetes (indicated by HbA1c MBS item) and at least 20% of these have completed an annual cycle of care, then the practice will receive a payment of $20 per patient per year (SWPE) with a HbA1c item number claimed.

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DIABETES RESOURCES

• Diabetes Management in General Practice Booklet
  
• National Diabetes Strategy 2000 - 2004
  
• Podiatry Insulin Initiation and Kidney Project (PIK Project)
  

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MENTAL HEALTH

MDGP supports general practice to facilitate patient access to optimal Mental Health Care and access to Psychological Services. MDGP delivers relevant continuing education to Practice Nurses and GPs.

AGPN Primary Mental Health

The Department of Health and Ageing Better Access section for Fact Sheets, Fees and Patient Rebates Charts and Frequently Asked Questions and Answers Fact Sheet

Better Access to Mental Health Care

On 1 November 2006 the Government delivered a major part of the COAG mental health package with the introduction of important new Medicare items to provide better and more affordable mental health care.

These new Medicare services promote a team approach to mental health care, with general practitioners encouraged to work with psychiatrists, clinical psychologists, and other allied mental health professionals to increase the availability of care.

Under the changes, Medicare rebates are available for GPs to provide early intervention, assessment and management of patients with mental disorders as part of a GP Mental Health Care Plan. A new GP Mental Health Care Consultation item is also available for GPs to provide continuing management of patients with mental disorders.

New Medicare items aim to support psychiatrists to see more new patients. The rebates for items 291 and 293, for psychiatrists to undertake patient assessment and preparation or review of a management plan to be carried out by the referring GP, will be increased significantly to support management of patients by GPs where appropriate.

Medicare items are available to provide rebates for psychological assessment and therapy services provided by clinical psychologists. Medicare items also cover the provision of focussed psychological strategies by appropriately trained allied mental health professionals, including psychologists, occupational therapists and social workers. QDGP Overview of Better Access Presentation

Better Access to Mental health Care Items Description

Description	Item	Fee	Medicare Rebate
GP Mental Health Care Plan	2710	$150	100%
GP Mental Health Care Plan Review	2712	$100	100%
GP Mental Health Care Consultation	2713	$66	100%
Consultant psychiatrist, referred patient assessment and management	291	$400	85% = $340
Consultant psychiatrist, review of referred patient assessment and management	293	$250	85% = $212.50
Medical practitioner attendance (including a general practitioner, but not including a specialist or consultant physician) associated with provision of focussed psychological strategies	2721	$80.35	100%
FPS EXTENDED ATTENDANCE Professional attendance for the purpose of providing focussed psychological strategies (from the list included in the Explanatory Notes) for assessed mental health disorders, by a medical practitioner registered with Medicare Australia as meeting the credentialing requirements for provision of this service, and lasting at least 40 minute	2725	$115	100%

For more information about Better Access please visit:

Search MBS online for explanatory notes and specific items
The Australian Divisions of General Practice Primary Mental Health website contains links to a Patient Pathways Chart, Better Access Flowchart and checklist for GPs.

GP Mental Health Care Plan/Review Electronic Templates available at:

• GP Partners website (electronic form)
  
• North East Valley Division website (MD compatible template)
  

To view the presentations from the BSDGP Mental Health Information Session held on 15 November 2006, please click on the links below:

• Overview of Better Access item numbers
  
• Presentation by the Australian Association of Social Workers
• Presentation by the Australian Psychological Society
• Presentation by OTs Australia

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Better Outcomes in Mental Health Care Initiative

The Federal Government initiative, which was released in 2001, seeks to improve the mental health care available to Australians by building a strong system of primary mental health care. It is acknowledged that General Practitioners are important providers of this care

In the past there have been many obstacles that have made it difficult for GPs to provide effective mental health care. Some of these obstacles include the time constraints in general practice, insufficient training in mental health care, and the difficulties experienced when trying to access services from other mental health care providers.

The BOiMHCI seeks to address some of these barriers by improving the mental health care available to Australians, building on and working with previous measures to provide a broad range of care options. The initiative also acknowledges that many GPs are already providing primary mental health care and aims to provide financial and other supports to address the barriers to management of mental health problems and disorders in general practice.

Who can participate?

Doctors eligible to participate in the BOiMHCI are medical practitioners, including GPs, but excluding specialists and consultant physicians. These doctors need also to have completed the relevant training requirements, and be practicing from a PIP or accredited practice.

The General Practice Mental Health Standards Collaboration (GPMHSC) is the body responsible for determining the education and training standards associated with the initiative. The GPMHSC also certifies the eligibility of GPs who complete the training requirements for access to the incentive payments. For more information about eligibility visit the GPMHSC.

1. Education and training for GPs

This component includes Familiarisation Training, Level 1 Training and Level 2 Training. Familiarisation Training aims to familiarise GPs with the BOiMHCI; Level 1 and Level 2 Training increase mental health skills, and are required to access certain components of the BOiMHCI.

2. The 3 Step Mental Health Process

Information about the Mental Health Assessment, Plan and Review also known as the 3 Step Mental Health Process. Note: GPs must have completed Familiarisation Training and Level 1 training and then register to claim the MBS item numbers for the 3 Step Mental Health Process

3. Focused Psychological Strategies

Focused Psychological Strategies are specific mental health care treatment strategies, derived from evidence based psychological therapies. They have been shown to integrate the best research evidence of clinical effectiveness with general practice and clinical expertise. The strategies and treatments that have been approved for use by GPs are limited to:

• Psycho-education
• Cognitive Behavioural Therapy
• Behavioural Interventions such as behaviour modification, exposure techniques and activity scheduling
• Cognitive Interventions such as cognitive analysis, challenging and restructuring, self-instructional training and attention regulation
• Relaxation Strategies guided imagery, deep muscle and isometric relaxation
• Skills Training such as problem solving skills training, anger management, stress management, communication training, social skills training, parent management traning, motivational interviewing
• Interpersonal Therapy (especially for depression)

These strategies are time limited, being deliverable, in up to 6 planned sessions and in some instances following review, up to another 6 sessions in any year to an individual patient. A session should last a minimum of 30 minutes.

In order for the GP to claim specific MBS item numbers for providing these strategies, GPs must be Level 2 trained in the Better Outcomes in Mental Health Care Initiative.

4. Access to Allied Health Services

The Allied Health Project is run by Brisbane South Division of General Practice with Commonwealth funding under the BOiMHCI. This Project enables GPs who are registered for the BOiMHCI to refer suitable patients to a Psychologist at no cost to the patient for short-term psychological therapy (up to 12 hours of therapy per patient). The mental health problems being targeted by this project are predominantly anxiety and depression related disorders, along with adjustment disorder and grief related issues. A number of Psychologists are employed by the Division and undertake consultations To be eligible to make referrals in the Allied Health Project you need to be registered for Level 1 of the BOiMCHI. If you would like to be involved with the Project please phone Vicky McAuliffe at the Division. For general information about Access to Allied Health Services Projects, please visit PARC.

5. Access to Psychiatrist Support

GP Psych Support is a free advisory service from Psychiatrists to assist GPs in the provision of mental health care for your patients. Access the service by: · Phone:1800 200 588. You will be asked some questions, provided with a case identification number, and given a time when a psychiatrist will phone you back. · Fax: (02) 9425 3879. A fax back form is available via the phone service. A psychiatrist will then fax or phone you to discuss case details. · E-mail: Secure, password protected website. Phone 1800 026 965 to obtain a username and password, then log on to www.psychsupport.com.au and register your question. A psychiatrist will e-mail you a response.

For more information about the BOiMHCI please visit the ADGP website, mental health page.

If you are a GP interested in registering in the BOiMHCI please refer to the General Practice Mental Health Standards Collaboration (GPMHSC) Beginners guide for more information. Alternatively you can contact Vicky McAuliffe at the Alliance for more information.

Quick Facts About the 3 Step Mental Health Plan

• Minimum 2 Consultations (Level C or D) of which 1 consultations must be a planned visit
  
• Multiple consultations may be required for any or all steps
  
• Medical records to document the 3 Steps and clinical content of mental health plan
  
• There is no maximum incentive payment per GP per financial year
  

Resources

Pro formas and a checklist are available to facilitate completion of the 3 Step Mental Health Process are available on our Templates Page. Pro forma are also available on Medical Director.

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MENTAL HEALTH LINKS

This section contains links to various websites with Mental Health information.

Access to Allied Health Pilots Projects - The ATAPS component of the BOiMHCI provides GPs with support from allied health professionals in treating people with a mental health disorder.

Auseinet - Auseinet informs, educates and promotes good practice in a range of sectors and the community about mental health promotion, prevention, early intervention and suicide prevention across the lifespan.

Australian Mental Health Consumer Network - A national representative mental health consumer voice, valuing consumer expertise, that enables full participation in Australian society.

Australian Psychological Society - The APS is the largest professional association for psychologists. The APS is committed to advancing psychology as a discipline and profession.

Beyondblue – The National Depression Initiative The organisation devoted to increasing awareness and understanding of depression in the community.

Black Dog Institute - Info on depression and Bipolar causes, treatments, online self-assessment tools, section for consumers & carers, research studies, professional education & training programs, & materials for clinicians.

General Practice Mental Health Standards Collaboration - Information for GPs, education providers and Divisions of general practice relating to the Better Outcomes in Mental Health Care initiative.

Healthinsite - You will find a wide range of up-to-date and quality assessed information on important health topics.

Kids in Mind - Mater Child and Youth Mental Health Service.

Mental Health Council of Australia - MHCA is the independent, national representative network of organisations and individuals committed to achieving better mental health for everyone. 33 Member Organisations (including ARAFMI, AICAFMHA, Australian Mental Health Consumer Network, Carers Australia, GROW, Lifeline Australia, Mental Illness Education Australia and SANE), beyondblue, MindMatters, Bluepages, Centre for Mental Health Research (ANU), MindBodyLife and Moodgym.

Mental Health and Well Being - The website of the Mental Health and Special Programs Branch Commonwealth of Australia Department of Health and Ageing.

Mental Health Association (Qld) - Mental health information and fact sheets, advocacy, health promotion, ethnic mental health Website provides links to: Schizophrenic Fellowship, ARAFMI, Mental Health&Wellbeing, National Rural Alliance, Qld Health, Beyond Blue, DepressioNet, Eating Disorders Assoc (Qld), The Healing Centre, Qld Transcultural Mental Health Centre, Head Room – Family Mental Health, Here for Life – Suicide Prevention, Griffith Uni Support for Self Harm, Self Harm Alliance, Infoxchange Service Seeker (Qld), Anxiety Network Australia, Social Anxiety Australia and Chryantheine – Ezine for Multiples.

Multicultural Mental Health Australia - MMHA provides national leadership in mental health and suicide prevention for Australians from culturally and linguistically diverse CALD) backgrounds.

Parenting and Family Support Centre - Based at the Univeristy of Queensland, PFSC is a specialist family intervention research and training facility.

Primary Mental Health Care Australian Resource Centre - PARC is a Clearinghouse and Electronic Library for Australian PMHC and an Information Service in PMHC for General Practitioners and the Divisions of General Practice. Webpage has links to Electronic Library, Shared Care Toolkit, Comorbidity web pages, educational resources and discussion lists.

Princess Alexandra Hospital Mental Health Services - Information about the PA Mental Health Services.

Queensland Transcultral Mental Health Centre - QTMHC is a statewide service which provides an information, referral, resource and clinical consultation service, funded by the Queensland Government.

Royal Australian and New Zealand College of Psychiatrists - The RANZCP is a Fellowship of Psychiatrists working together with and for the general community to achieve the best attainable quality of psychiatric care and mental health.

Triple P International - Positive Parenting Program (Triple P)

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LIFESCRIPTS

What is Lifescripts?

Lifestyle Prescriptions (or Lifescripts) aims to build on preventive activities being undertaken in the primary health care system. Lifescripts provides general practice with tools to assist patients to make healthier lifestyle choices. Building on work undertaken on the SNAP lifestyle risk factors Lifescripts covers those risk factors (Smoking, Nutrition, Alcohol and Physical activity) and adds weight management as an additional risk factor.

Lifescripts provides a framework for GPs, Practice Nurses and staff in the general practice setting to bring lifestyle risk factors to the fore in their engagement with patients. Implementing Lifescripts involves: discussing risk factors with patients; setting lifestyle change goals; providing written lifestyle prescriptions; organising ongoing review of lifestyle risk factors; and referring patients to other services that support healthy lifestyle choices.

Lifescripts is a national initiative, implemented through local divisions of general practice, promoting risk factor management in general practice and primary health care services. Lifestyle prescriptions are tools for GPs to use when providing lifestyle advice to patients. Advice may be about quitting smoking, increasing physical activity, eating a healthier diet, maintaining healthy weight, reducing alcohol consumption, or a combination of these.

Lifestyle Prescriptions is funded by the Australian Government Department of Health and Ageing, more background information can be found on the DOHA  website

Lifescripts utilises the SNAP framework developed by the Royal Australian College of General Practitioners as a platform, the SNAP Framework is available on the RACGP website.

In 2005 the Australian Government Department of Health and Ageing commissioned the Divisions network to roll out the implementation of Lifescripts. AGPN has received funding for a National Lifestyle Prescriptions Coordinator, and the Networks State Based Organisations have also received capacity to provide support to participating Divisions. For further information on Lifescripts Implementation.

Lifescripts links to other initiatives such as:

• Pregnancy Lifescripts
  
• 45-year-old Health Check
  

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LIFESCRIPTS RESOURCES

There are many resources that support the Lifescripts Initiative they can all be found at one easy location at the Lifescripts Resource Library.

Lifescripts Resources Kits for General Practice are kept on site at MDGP in the rear of the seminar room. They consist of two resource packs:

Practice Kit

• Practice manual
  
• Posters
  
• Patient Brochures and stand
  
• Lifescripts paper
  

Risk factor Resource Kit

• Assessment Pads
• Prescription pads
  
• The five A’s Chart/Evidence of benefits chart
  
• Patient File stickers
  

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YOUR CONTACT

Karin Barron
MSOAP Program Officer
Mackay Division of General Practice
43 Evans Avenue
North Mackay
Queensland, 4740

Telephone: 07 4953 4491
Email:

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Last Updated: September 21 2009 16:19:09.