title: General practitioner management plans delaying time to next potentially preventable hospitalisation for patients with heart failure.
abstract: BACKGROUND
  Several studies have shown that the Australian Medicare-funded chronic disease management programme can lead to improvements in care processes. No study has examined the impact on long-term health outcomes.
  
  
  OBJECTIVE
  This retrospective cohort study assessed the association between provision of a general practitioner management plan and time to next potentially preventable hospitalisation for older patients with heart failure.
  
  
  METHODS
  We used the Australian Government Department of Veterans' Affairs (DVA) claims database and compared patients exposed to a general practitioner management plan with those who did not receive the service. Kaplan-Meier analysis and Cox proportional hazards models were used to compare time until next potentially preventable hospitalisation for heart failure between the exposed and unexposed groups.
  
  
  RESULTS
  There were 1993 patients exposed to a general practitioner management plan and 3986 unexposed patients. Adjusted results showed a 23% reduction in the rate of potentially preventable hospitalisation for heart failure at any time (adjusted hazard ratio, 0.77; 95% confidence interval, 0.64 to 0.92; P = 0.0051) among those with a general practitioner management plan compared with the unexposed patients. Within one year, 8.6% of the exposed group compared with 10.7% of the unexposed group had a potentially preventable hospitalisation for heart failure.
  
  
  CONCLUSIONS
  A general practitioner management plan is associated with delayed time to next potentially preventable hospitalisation for heart failure.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, Australia.
authors.forename: A I
authors.initials: AI
authors.lastname: Vitry
authors.forename: T A
authors.initials: TA
authors.lastname: Nguyen
authors.forename: E N
authors.initials: EN
authors.lastname: Ramsay
authors.forename: G E
authors.initials: GE
authors.lastname: Caughey
authors.forename: A L
authors.initials: AL
authors.lastname: Gilbert
authors.forename: S
authors.initials: S
authors.lastname: Shakib
authors.forename: P
authors.initials: P
authors.lastname: Ryan
authors.forename: A
authors.initials: A
authors.lastname: Esterman
authors.forename: R A
authors.initials: RA
authors.lastname: McDermott
authors.forename: E E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D019468:Disease Management; D005260:Female; D058005:General Practitioners / Q000639:trends; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
keywords: aged; general practice; heart failure; plan; population