From referral to reality: utilisation of Medicare-funded allied health services among people with newly diagnosed diabetes

BACKGROUND: To investigate how Medicare-funded chronic disease management services are utilised by people with newly diagnosed diabetes, and the patient characteristics associated with receiving multidisciplinary care. METHODS: This prospective cohort study used baseline survey data from the 45 and Up Study, Australia, linked to administrative health records to identify individuals newly diagnosed with diabetes from 2011 to 2017. Medicare Benefits Schedule data were used to identify claims for general practitioner management plans (GPMPs), team care arrangements (TCAs) and allied health services within 24-months of diagnosis (follow up to 31 December 2019). Multivariable logistic regression models were used to identify patient characteristics associated with receiving multidisciplinary care. RESULTS: Of 12,694 newly diagnosed diabetes cases, two-thirds (67.9%) received a GPMP, 61.0% received a GPMP and TCA, and 45.8% claimed for at least one allied health service within two years of diagnosis. Allied health service use was highest for podiatrists (26.3% with ≥1 claim) and lowest for diabetes educators (6.0%). Women, individuals aged ≥75 years, English-speakers, and those with obesity had higher odds of receiving a GPMP and progressing along the chronic disease management care pathway to allied health service use. In contrast, individuals from remote areas had lower odds of accessing allied health services (aOR 0.29, 95% CI: 0.20-0.43). CONCLUSIONS: The findings of this study reveal substantial underutilisation of Medicare-funded chronic disease management services, in particular allied health services, during the crucial period following diagnosis. Targeted strategies are needed to improve initiation of care planning by GPs, and to ensure equitable access to government-funded allied health services.