Geographical variation in health service use by people living with dementia

The Medicare Benefits Schedule (MBS) data collection contains claims data for Medicare services subsidised by the Australian Government. MBS events were grouped according to the MBS codes in Table 6.

Notes:

1. BTOS = Broad Type of Service.

2. Telehealth, MBS group M18 and A40, were introduced in March 2020 and June 2021 respectively.

• A general practitioner (GP) is likely the first point of contact for health care and is important in the coordination of care of patients and referral to other health care services.
• GP chronic disease management (CDM) attendances are those relating to the preparation, coordination and review of a GP Management Plan or Team Care Arrangements, or the contribution to a Multidisciplinary Care Plan for patients with a chronic or terminal medical condition, to help ensure they receive structured and coordinated care that will help them to achieve their current health goals.
• Nursing and/or Aboriginal health worker attendances are provided in collaboration with, or under the supervision of, medical practitioners. This includes services provided by Practice Nurses, Nurse Practitioners, Aboriginal health workers, and Aboriginal or Torres Strait Islander health practitioners.
  • It should be noted that these data only include services receiving a Medicare rebate. Nursing and Aboriginal health worker services funded through the Workforce Incentive Program Practice Stream are not included.
• A specialist attendance is a Medicare subsidised referred patient/doctor encounters involving medical practitioners who have been recognised as specialists or consultant physicians for Medicare benefits purposes. Data are presented for the following specialist attendances:
  • Geriatric medicine specialists (or geriatricians) care for people over the age of 65. Most geriatricians have expertise in dealing with people who have multiple conditions. People with younger onset dementia may also see a geriatrician (AIHW 2022). These data include Geriatrician Referred Patient Assessment and Management Plan attendances, which accounted for 42% of geriatrician attendances for people living in the community and 52% of geriatrician attendances for people living in residential aged care.
  • Psychiatrists are medical doctors who have completed specialised training in how to diagnose, treat and prevent mental, emotional and behavioural disorders. A person with dementia may see a neuropsychiatrist, a psychiatrist who specialises in the interface between psychiatry, neurology and general medicine.
  • Neurologists diagnose and treat conditions of the brain, spinal cord and nerves. This can include muscle diseases and disorders that affect thinking and behaviour.
  • General Physicians provide a range of non-surgical health care to adult patients.
• The allied health sector represents a range of services provided by health practitioners who are generally university qualified and with specialised expertise in preventing, diagnosing and treating a range of conditions and illnesses. Data are presented for the following allied health care attendances:
  • Podiatrists help people in the care of their lower limbs including the foot and ankle and may also be involved in supporting older people to reduce their risk of falling.
  • Optometrists are experts in eye health, trained to prescribe spectacles and contact lenses and treat a range of eye conditions such as dry eye, allergies and infections.
• Medication management reviews are undertaken by GPs in collaboration with community pharmacists and specialists as well as in discussion with the patient and their carer. They aim to help people to get the most benefit from their medicines and minimise their risk of medicines-related harm.

References

AIHW (2022) Younger onset dementia – new insights using linked data, AIHW, Australian Government, accessed 1 December 2022.