OBJECTIVES:To examine two decades of Australian expenditure trends across components of primary health and to assess whether recent expenditure changes have been equitably distributed. STUDY TYPE:Descriptive modelling using standardised framework for classifying primary care expenditure. SETTING:Australian public and private health expenditure data (2002-03 to 2022-23) were disaggregated into: broad primary health care services (Tier A); direct primary care, predominantly funding general practice (Tier B); and funding for enhanced primary care for people with greater needs (Tier C). Distributional analysis was conducted across geographies. PARTICIPANTS:No individual participants; analysis used aggregated health expenditure data across 327 Statistical Area Level 3 geographies. MAIN OUTCOME MEASURES:Proportions of total and public expenditure allocated to each tier; equity in public Tier B and Tier C spending across areas, assessed using standardised slope indices. RESULTS:The share of total health spending allocated to primary care declined over the period. Tier A spending declined from 36.3% to 33.0% of total health spending; Tier B fell more sharply from 8.0% to 5.5%; and Tier C remained flat at 0.7%. Public spending trends were similar, but declines were more muted, with Tier C unchanged at 1.0%. Public spending on Tier B was 13% higher in the most disadvantaged areas than in the most advantaged areas in 2013-14; by 2023-24, this declined to 7%. Public Tier C spending remained progressive at 35% higher in the most disadvantaged areas, but decreased from 51% over the decade. Exploratory multivariate analyses suggested that Tier C spending was more redistributive than Tier B after accounting for need. CONCLUSIONS:Data indicate that primary care has declined as a funding priority in relative terms in Australia, and investment in high-value care has remained stagnant and appears increasingly less redistributive. These patterns may have implications for health equity.

ObjectivesTo assess the distribution of health care expenditure (public and private) for primary care and primary health care as proportions of overall health care funding.Study designThe Primary Care Spend model; estimated distribution of expenditure for three tiers of primary care services by provider and function.SettingPrimary Care Spend model applied to Australian health expenditure, public and private, 2020-21, from a health sector perspective, as recorded by the Australian Institute of Health and Welfare.Main outcome measuresProportions of all health care spending for essential community and primary health care functions (tier A), comprehensive primary care (services delivered in general practices and family physician clinics; tier B), and enhanced primary care services (long-term holistic patient care; tier C).ResultsIn 2020-21, 33.2% of health spending in Australia was classified as primary health care spending (tier A), 6.0% as comprehensive primary care services (tier B), and 0.8% as long term holistic patient care services (tier C).ConclusionsThe application of the Primary Care Spend model to Australian data provides a more nuanced analysis of expenditure for primary health care than routine health expenditure reports. Its output could be used to inform targets for spending on different tiers, types, and locations of primary care, especially comprehensive and other high value primary care services, and to monitor progress toward these targets.

OBJECTIVES:To identify publications examining the enablers of and barriers to patient enrolment in primary care and its impact on continuity and quality of care; to assess the likely effectiveness of voluntary patient enrolment (MyMedicare) in Australia with regard to improving continuity of care and supporting other health care reforms. STUDY DESIGN:Scoping review of peer-reviewed journal article published in English during 1 January 2014 - 12 July 2024 that evaluated primary care enrolment models, including patient enrolment enablers and barriers. DATA SOURCES:PubMed, Cochrane Database of Systematic Reviews, Embase, CINAHL (Cumulated Index in Nursing and Allied Health Literature), PsycINFO, PAIS (Public Affairs Information Service), Web of Science, Scopus. The bibliographies of included articles were checked for further relevant publications. DATA SYNTHESIS:The database searches and bibliography checks identified 508 potentially relevant articles; we reviewed the full text of 66 articles after title and abstract screening, of which 24 publications met our inclusion criteria. Twenty-two of the included studies were undertaken in fifteen countries, including eleven in Canada, four in Australia, and two each in the United Kingdom and New Zealand; one publication compared schemes in twelve countries, one was a rapid review. The characteristics of patient enrolment models differ greatly between countries in both form and implementation, including the mandatory and voluntary components. We found little evidence that enrolment improved continuity of care. However, existing patient engagement with usual general practitioners was high among participants in many studies, and some studies involved patients who may already have had high levels of continuity of care. There is evidence that enrolment can support primary care reforms, including preventive care and the management of chronic conditions, and that other reforms, such as incentives and increased access to services can affect the enrolment of patients and practices. People in marginalised groups or with complex care needs are less likely to enrol with practices or practitioners. CONCLUSIONS:The Australian voluntary patient enrolment scheme should be continuously evaluated to assess levels of engagement by patients and general practices, drawing on the experiences of other countries in which similar schemes operate. Further assessment of overseas enrolment systems could identify reasons for the different experiences reported, as well as enablers of and barriers to successful implementation and better health outcomes.

A previously published review on primary care enrolment schemes found substantial variations in their characteristics, each with the potential to affect their ability to ensure people have access to primary care and continuity in their care. For this Review, we developed a typology informed by qualitative analysis of 15 schemes in 12 high-income countries for effective comparisons and informed policy making. We obtained policy documents from the websites of relevant government organisations and used inductive coding and thematic analysis to classify and group the schemes according to their core characteristics. Two distinctive features emerged: whether patients could attend other practices (ie, restricted or unrestricted) and whether there were different types of financial or non-financial incentives to enrol or attend enrolled practices, resulting in eight clusters of enrolment types. The identified typologies can assist researchers and policy makers in comparing and interpreting outcomes reported in the literature on patient enrolment schemes, including their impact on continuity of care. This study is particularly relevant to primary care reforms considering patient enrolment.

Background:There is increasing use of multi-disciplinary teams (MDT) to increase the quality of and access to primary care. For example, the promotion of MDTs in primary care is one of four recent major policy recommendations in Australia. This review sought to understand the impact of MDT on the quality of primary care, including continuity of care, and the enablers and barriers to implementation. Methods:A scoping review was undertaken of peer-reviewed journal articles published between 1 January 2014 and 13 August 2024. It is registered at OSF: DOI:10.17605/OSF.IO/23QYU. A search of PubMed, Cochrane, Embase, CINAHL, PAIS, Web of Science, PsycINFO, and Scopus databases yielded 1603 records or 770 articles after duplicates were removed; 75 full-texts were reviewed and 27 studies met the inclusion criteria. The search was repeated for the period 13 August 2024 to 13 August 2025, which yielded a further 282 records after duplicates were removed; 19 full-texts were reviewed and an additional 12 papers met the inclusion criteria reflecting the increasing interest in MDT-care in primary care reforms. Data extracted from the 39 papers in scope included the characteristics of MDT care reported, the outcomes observed, and the enablers and barriers to implementation. A socio-ecological model was used to examine the system, organisational, professional and patient level factors that enabled MDT-care in general practice. Findings:Data showed the models of MDT-care varied substantially. They ranged from multiple providers working together to care for a patient, to interprofessional teams providing patients the option to see an alternative provider. Analysis showed mixed outcomes from MDTs in primary care, driven by contextual, policy, organisational, professional and patient factors. In some cases, MDT strengthened the management of chronic disease. In other cases, MDT reduced continuity of care by fragmenting relational continuity. MDT care also impacted access to care, comprehensiveness of care, and coordination of care-in some cases positively, and other cases negatively. Interpretation:While there may be common preconditions at the systems, organisational, professional and patient level, effective MDT-care was likely to be goal and context specific. The introduction of MDTs will require careful planning and implementation to ensure that the potential benefits of MDT are realised and that it does not compromise the quality of primary care. Funding:The International Centre for Future Health Systems is supported by funding from The Ian Potter Foundation.

Patient enrolment in primary care refers to the formal process of registering patients with a specific primary care provider, team, or practice. This approach is often expected to enhance continuity and coordination of care. However, limited information exists on the uptake of patient enrolment and its associated characteristics. This review aimed to estimate the uptake of patient enrolment in primary care and examine factors associated with decisions around enrolment. Eight electronic databases (PubMed, Cochrane Register of Systematic Reviews, Embase, CINAHL, PsycINFO, PAIS, Web of Science, and Scopus) were searched for peer-reviewed articles published from January 2014 to July 2024. Findings from included studies were extracted and synthesised, with uptake estimated through meta-analysis and factors associated with enrolment summarised narratively. Review registration: PROSPERO CRD42024597078. Ten studies across nine publications were included. Of these, eight studies with 27,919,216 participants were included in the meta-analysis. The results showed a pooled patient enrolment uptake rate of 71.4

BackgroundStrong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses.MethodsWe conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis.ResultsFrom 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten 'pressure points' affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system.ConclusionsPCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived 'pressure points' that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design.

Background:Mobile health (mHealth) apps are increasingly being used to capture patient health data, provide information, and guide self-management, with reported improvements in health care service delivery and outcomes. However, the impact of integrating mHealth app data into electronic medical record or electronic health record (EMR/EHR) systems remains underexplored. Objective:This study aims to identify what is known about the impact of integrating mHealth app data into EMR/EHR systems on health care delivery and patient outcomes. Methods:A scoping review was conducted to identify original studies that investigated the integration of patient-facing mHealth app data into EMR/EHR systems and the impact on health care outcomes. The PubMed, Embase, Web of Science, Cochrane Library, CINAHL, ProQuest, and PsycINFO databases were searched for papers published between January 2014 and July 2024. Two authors independently screened and extracted data on study characteristics, mHealth app features, details of integration with EMR/EHR systems, and effects on health care delivery and patient outcomes. Results:Nineteen studies with 113,135 participants were included. Among these, 6 were randomized clinical trial studies, 8 were conducted in the United States, 12 occurred in hospital settings, 15 involved adult participants, and 6 targeted diabetes management. Main features of the apps and EMR/EHR systems can be categorized into tracking or recording health data (n=19), app data integrated into EMR/EHR systems (n=19), app data summarized or presented on EMR/EHR interface (n=19), communication with the health care team (n=12), reminders or alerts (n=10), synchronization with other apps or devices (n=8), educational information (n=4), and using existing portal credentials to app access (n=2). Most studies reported benefits of integrating the app and EMR/EHR, such as enhanced patient education and self-management (n=5), real-time data recorded and shared with clinicians (n=4), support for clinical decision-making (n=3), improved communication between patients and clinicians (n=7), and improved patient outcomes (n=13). Challenges identified included high drop-off rates in app usage (n=3), limited accessibility due to device restrictions (n=3), incompatibility between mHealth apps and EMR/EHR systems (n=3), increased clinical workload in response to additional information (n=3), data accuracy issues due to network connectivity (n=1), and data security concerns (n=1). Conclusions:Evidence suggests that the effective integration of mHealth app data into EMR/EHR systems can enhance both clinicians' health care delivery and patients' health outcomes. However, current literature is limited, and future opportunities remain to examine the impact on long-term outcomes, such as mortality, readmissions, and costs, and assess the scalability and sustainability of integration among more broader health conditions and disabilities across diverse health care settings.

BACKGROUND:It is uncertain if patient's characteristics are associated with complaints and claims against doctors. Additionally, evidence for the effectiveness of remedial interventions on rates of complaints and claims against doctors has not been synthesised. METHODS:We conducted a rapid review of recent literature to answer: Question 1 "What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?" and Question 2 "What initiatives or interventions have been shown to be effective at reducing complaints and claims about the care patients have received from a doctor?". We used a systematic search (most recently in July 2023) of PubMed, Scopus, Web of Science and grey literature. Studies were screened against inclusion criteria and critically appraised in duplicate using standard tools. Results were summarised using narrative synthesis. RESULTS:From 8079 search results, we reviewed the full text of 250 studies. We included 25 studies: seven for Question 1 (6 comparative studies with controls and one systematic review) and 18 studies for Question 2 (14 uncontrolled pre-post studies, 2 comparative studies with controls and 2 systematic reviews). Most studies were set in hospitals across a mix of medical specialties. Other than for patients with mental health conditions (two studies), no other patient characteristics demonstrated either a strong or consistent effect on the rate of complaints or claims against their treating doctors. Risk management programs (6 studies), and communication and resolution programs (5 studies) were the most studied of 6 intervention types. Evidence for reducing complaints and medico-legal claims, costs or premiums and more timely management was apparent for both types of programs. Only 1 to 3 studies were included for peer programs, medical remediation, shared decision-making, simulation training and continuing professional development, with few generalisable results. CONCLUSION:Few patient characteristics can be reliably related to the likelihood of medico-legal complaints or claims. There is some evidence that interventions can reduce the number and costs of claims, the number of complaints, and the timeliness of claims. However, across both questions, the strength of the evidence is very weak and is based on only a few studies or study designs that are highly prone to bias.

Background This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption. Methods Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model. Results CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision. Conclusions This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs’ effectiveness and the acceptance of their role within the healthcare team.

BACKGROUND:Australia is undergoing general practice funding reform, with recent changes to Medicare and the introduction of MyMedicare voluntary patient registration. OBJECTIVE:Within this context, we provide general practitioners (GPs) with an explainer on health economic concepts relevant to current funding reform debates. This article outlines different funding model types, discusses the theoretical advantages and disadvantages of each funding model, and reflects on past experiences of reform. DISCUSSION:Common GP funding models across the world include fee for service, capitation, pay for performance and bundled payments. Each funding model has its potential advantages and disadvantages. Blended funding models can minimise undesired consequences of individual funding models but can introduce additional complexity. The challenge remains to design funding models that enable access to quality care, adequately pay providers and are sustainable into the future.

Public services, such as health and other human services, are increasingly being delivered by third-party providers (providers) under contract to public sector organisations (PSOs). While often advantageous to PSOs, this creates a fragmented service context which is difficult for consumers to navigate. Further, providers often deliver services under multiple contracts to multiple funders, with high reporting requirements, high administrative costs, and low operational sustainability. Policymakers have encouraged co-commissioning-where PSOs come together to jointly commission services-to increase the efficiency and effectiveness of outsourcing. This article seeks to understand the costs of co-commissioning in Australia, and consequently the enablers and barriers to co-commissioning. This qualitative study is based on the early experiences of co-commissioning by one of 31 Primary Health Networks (PHNs). Using transaction cost economics (TCE) theory, the study explains how the PHN started co-commissioning services with other PHNs, before co-commissioning with other types of organisations. The PHN also co-commissioned relatively simple activities first, before moving on to more complex services. The insights provided using TCE theory help explain why co-commissioning is initially complicated (and costly), requiring time to understand both the services to be commissioned and the governance requirements of each party involved. While initial transaction costs may be high when co-commissioning, this may reflect organisational learning and capacity development costs - therefore, costs are expected to reduce over time.Points for practitionersFragmentation in policy and funding also leads to fragmentation of human services and high costs to service providers.Co-commissioning is where multiple funders pool funds and strategically commission services together.Co-commissioning offers a way to reduce fragmentation and reduce costs to service providers, potentially offering better public value.Co-commissioning can initially take time and resources to establish.Over time, as organisations learn, the cost of co-commissioning reduces potentially offering benefits to funders, providers, and service users.

BackgroundReferrals are a criticai component of the Australian healthcare system, with referrals from general practitioners (GPs) to non-GP specialists making up the majority of medicai referrals. Given the key role referrals have in primary healthcare, it is important that GPs understand their legal and professional responsibilities when providing a referral and ensure they refer appropriately and effectively to provide the best health outcomes for patients.ObjectiveThis article explores GP referrals to other health professionals and aims to describe a doctor's medicolegal obligations and responsibilities when making a referral.DiscussionThe responsibility of GPs in the referral process reflects their central coordinating role as providers of primary care, and the reliance patients place upon them to advise and recommend treatment and investigations. Understanding the medicolegal obligations and responsibilities when writing a referral can help GPs find the right balance between respecting patient autonomy and the professional obligation to take reasonable steps to ensure referrals and investigations are acted upon appropriately. The key to an effective referral process is clear communication between practitioners and patients, to help align the expectations of ali involved so they can agree and implement a shared treatment plan in the interests of the patient.