Melbourne dietitians' experience of medicare policy on allied health services (strengthening medicare; Enhanced Primary Care) in the first 12 months

Objective: To describe Victorian private practitioner dietitians' experience of the Enhanced Primary Care (EPC) program funded under national heath insurance. Design: Dietitians' experience of the EPC program was investigated between August 2004 and July 2005. A purposive sample of 10% (n = 15) of Victorian dietitians in private practice was interviewed via semi-structured interviews or focus groups. Focus group/interview data were audio-taped, transcribed verbatim and thematically analysed using NVIVO software to manage data. Subjects: Victorian dietitians. Setting: Dietetic private practice. Main outcome measures: Issues identified from narrative themes. Results: Thirteen (86%) participants were registered with the Medicare Australia and managed EPC-referred patients. Two chose not to. All those using the program supported it but voiced frustrations experienced in the first year. Five themes emerged from narrative analysis involving difficulties with implementation in the following areas: referral issues, client preparedness, annual number of consultations limit, impact of financial cost on client and non-reimbursed administration costs. Conclusion: For clients with chronic illness, access to dietitians in private practice under Medicare EPC is an important service. As increasing numbers of dietitians nationally work with EPC patients with chronic illness or complex care needs, there is a need for information sharing between professional groups about billing procedures and chronic care management. More dietitians need to structure practice to initiate bulk-billing. Rigorous evaluation is needed to understand which diagnosis types can benefit from the program and to implement an evidence-based model of chronic care improvement for dietetics consultations.