title: Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians' private practices.
abstract: OBJECTIVE
  This study explored private practice dietitians' perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients.
  
  
  METHODS
  Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians' perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding.
  
  
  RESULTS
  Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines.
  
  
  CONCLUSIONS
  The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required.
authors.affiliation: Centre for Health Practice Innovation, Griffith University Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia. Email.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jansen
authors.affiliation: Centre for Health Practice Innovation, Griffith University Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia. Email.
authors.forename: Lauren
authors.initials: L
authors.lastname: Ball
authors.affiliation: Dietitian Services Qld, Zillmere, Qld 4034, Australia. Email.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lowe
mesh_terms: D001315:Australia; D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D007407:Interviews as Topic; D009313:National Health Programs / Q000706:statistics & numerical data*; D064686:Nutritionists; D011331:Private Practice; D036301:Qualitative Research