University of Queensland. Monash University. Southern Health Victoria
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1 Michele Foster 1 Michele Haynes 1 Martin O Flaherty 1 Geoff Mitchell 1 Elizabeth Skinner 2 Terry Haines 2,3 1 University of Queensland 2 Monash University 3 Southern Health Victoria
2 Emphasis on multidisciplinary care for people with chronic disease Improve access to allied health services Out-of-pocket costs and system barriers Medicare rebates for allied health services Discipline-specific evaluations Allied health services can be viewed as discretionary 1,2 1 Foster et al. (2009) Aust J Primary Health; 2 Foster & Mitchell (Under review) Health Expectations.
3 Interest in use of allied health services and influence of health insurance Use of health services linked to combination of factors Social, demographic, structural (predisposing), economic and other situational (enabling) and health-related (need) factors 3 3 Andersen R., Newman J (1973) Milbank Memorial Quarterly; 51:
4 Research Aims Examine how key variables interact with use of allied health services among people with chronic disease Examine how health insurance coverage might influence use of allied health services
5 1. Systematic review Meta-analysis and critical, narrative synthesis 2. Survey data analysis National Health Survey (NHS) and Australian Longitudinal Study of Women s Health data Some data restrictions due to changes in question wording over time/between cohorts
6 Health insurance and use of allied health services Factors influencing use amongst people with chronic disease independently of health insurance How health insurance influences use Develop a conceptual model *This component of the APHCRI project was led by A/Professor Terry Haines, Monash University
7 Source: Foster, Haynes, O Flaherty, Mitchell, Skinner, Haines (2012) Utilisation of allied health services. Final Report
8 Social and demographic (predisposing) Age and use inconsistent Ethnicity and use varied (clinical population, type of service) Education and use varied (type of service) Economic and situational (enabling) Income and use inconsistent Health-related (need for service) Comorbidity and severity Physician visits linked to more frequent use
9 Features of the insurance product Administrative (gate-keeper role, containment) Eligibility, limits, quantity Reimbursement and out-of-pocket costs gate-keeper factors Knowledge, perceived benefits Provider factors Willingness to provide services Factors related to the patient Knowledge, perceived need, cost and benefit
10 NHS 2001 and Key outcome: visits/use allied health Previous 12 months Descriptive analyses to explore patterning of key demographic, health status, health care variables Logistic regression models to examine predictors of use of allied health service
11 Women more likely to use AHPs than men The size of the gender gap is greater postretirement age
12 Age and Sex Percentage visied allied health professional (previous fortnight) 15.00% 10.00% 5.00% 0.00% Allied health visits Age Male Female Percentage visied allied health professional (previous year) 40.00% 30.00% 20.00% 10.00% 0.00% Allied health visits Male Female Age
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14 Speaking language other than English at home less likely to use AHPs English language proficiency English only Well/very well Not well/not at all *** ***
15 Ancillary insurance has a strong positive effect on use Interesting three way relationship between ancillary insurance, general health and allied health service use
16 Percentage visited allied health professional (previous year) 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Allied health usage /8 Excellent Very good Good Fair Poor Self-reported health No ancillary insurance Has ancillary insurance
17 Visiting a GP is associated with visiting an AHP, independently of health GP contact Visited GP past fortnight 1.74*** - < Annual checkups ** 6 monthly/annual checkups Monthly/3 Monthly checkups *** ***
18 Musculoskeletal conditions are the most consistently associated with AHP use However, diabetes has the largest effect in the analysis
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21 High and low users of allied health services Linked to need? Over-use? Financial hardship? Use by men and CALD populations What is clinically significant? Targeted research with different population groups
22 Importance of health professional as agent Potential disparities where there is poor access to GPs 4 Balance discretion and guidance Improving evidence base and communication about benefits 4 Bywood et al PHCRIS Policy Issue Review
23 Ancillary insurance linked to AHP use Use increases with both poorer health and uptake of insurance People in poor health with/without ancillary are high users Extent of financial hardship publicly v. privately funded Complexity surrounding insurance product
24 Possible but unknown influence of policy environment Diabetes suggest potential of CDM policy High users podiatry and dietitian services in NHS data Increased uptake CDM items and podiatry services since Unknown mix and shifts between public/private 1 5 Cant & Foster 2011 Aust Health Review; 1 Foster et al (2009) Aust J Primary Health
25 Use of allied health services is conceptually complex Potential multiple factors of influence and other drivers (e.g. patient preference) Is it equitable use? Need, severity, timing, affordability Is it effective and cost-effective use? Limited evidence base
26 Other contextual factors impacting use Programs for specific groups Distribution of services, inc. public and private Market forces Quality longitudinal data is important Limitations of NHS data and systematic review
27 Research team: Michele Haynes, Martin O Flaherty, Geoff Mitchell (UQ), Elizabeth Skinner, Terry Haines (Monash) Project funded by the Australian Primary Health Care Research Institute, supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy
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