title: Revenue effects of practice nurse-led care for chronic diseases.
abstract: OBJECTIVE
  To determine the economic feasibility in Australian general practices of using a practice nurse (PN)-led care model of chronic disease management.
  
  
  METHODS
  A cost-analysis of item numbers from the Medicare Benefit Schedule (MBS) was performed in three Australian general practices, one urban, one regional and one rural. Patients (n =254; >18 years of age) with chronic conditions (type 2 diabetes, hypertension, ischaemic heart disease) but without unstable or major health problems were randomised into usual general practitioner (GP) or PN-led care for management of their condition over a period of 12 months. After the 12-month intervention, total MBS item charges were evaluated for patients managed for their stable chronic condition by usual GP or PN-led care. Zero-skewness log transformation was applied to cost data and log-linear regression analysis was undertaken.
  
  
  RESULTS
  There was an estimated A$129 mean increase in total MBS item charges over a 1-year period (controlled for age, self-reported quality of life and geographic location of practice) associated with PN-led care. The frequency of GP and PN visits varied markedly according to the chronic disease.
  
  
  CONCLUSIONS
  Medicare reimbursements provided sufficient funding for general practices to employ PNs within limits of workloads before the new Practice Nurse Incentive Program was introduced in July 2012.
authors.affiliation: School of Accounting, Finance and Economics, Griffith University, 170 Kessels Road, Nathan, Qld 4111, Australia. Email:
authors.forename: Richard A
authors.initials: RA
authors.lastname: Iles
authors.affiliation: School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Qld 4006, Australia. Email:
authors.forename: Diann S
authors.initials: DS
authors.lastname: Eley
authors.affiliation: Curtin University, School of Nursing and Midwifery, GPO Box U1987, Perth, WA 6845, Australia. Email:
authors.forename: Desley G
authors.initials: DG
authors.lastname: Hegney
authors.affiliation: Department of Nursing, School of Health Sciences, The University of Melbourne, Room 606, Level 6, Allan Gilbert Building, 161 Barry Street, Melbourne, Vic. 3010, Australia. Email:
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Patterson
authors.affiliation: School of Nursing and Midwifery, The University of Queensland, Herston, Qld 4111, Australia. Email:
authors.forename: Jacqui
authors.initials: J
authors.lastname: Young
authors.affiliation: Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld 4229, Australia. Email:
authors.forename: Christopher
authors.initials: C
authors.lastname: Del Mar
authors.affiliation: School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Qld 4006, Australia. Email:
authors.forename: Robyn
authors.initials: R
authors.lastname: Synnott
authors.affiliation: Centre for Applied Health Economics, School of Medicine & Population and Social Health Research Program, Griffith Health Institute, Griffith University, Nathan, Qld 4111, Australia. Email:
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002908:Chronic Disease / Q000451:nursing*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses' / Q000191:economics*