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Table 1 Aged care systems and policies in Australia and Sweden

From: Factors influencing deprescribing for residents in Advanced Care Facilities: insights from General Practitioners in Australia and Sweden

 

Australia

Sweden

Population ≥65 years

15 % [21]

20 % [22]

Population ≥65 in ACF

7.8 % [23]

5 % [22]

Number of medications per ACF resident

7–10 [3, 4, 24]

7–10 [25, 26]

(>70 % have one or more PIM)

ACF providers

• Private not-for-profit [27]

• Private for-profit [27]

• Municipality (responsible)

• Private (paid by municipality) [28]

General practice structure

• Single/multiple GP private practices [29]

• Small − medium business model [29]

• Team-based primary care facilities

• Most public (owned by the county councils)

• Few private (mostly owned by companies or cooperatives) [30]

GPs in ACF

• Continuity model: GP follows long-term patient to ACF [31]

• ACF panel model: GP provides care for >2 patients in nearby ACF [31]

• GPwSI ACF model: GP provides regular scheduled service to large number of ACF residents [31]

• LGPT model: GP part of team-based care [31]

• ACF-based model: Single GP partners with single ACF [31]

• County councils responsible for residents’ medical care; generally weekly visit to ACF by one GP from the local primary care unit [28]

Funding for primary health care

• Government funded (both state-, territory- and local-)

• Fee-for-service paid directly by patients and clients

• Private health insurers

• Private charities [32]

• Funded through national and local taxation [30].

GP funding structure

• Fee-for-service paid directly by patients, and/or

• Reimbursement by Government Medicare Benefits Schedule [29]

Different funding in the 20 different county councils [33]. In Skåne where interviewed GPs worked [34]:

• Based on capitation for registered patients.

• Complemented with estimated ‘illness burden’ indexation

• Performance-based payments

Medication reviews for ACF residents

• Pharmaceutical review outsourced by ACF to private company or local pharmacist.

• Compulsory biennially as part of ACF accreditation process [35].

• GP may request local pharmacist to undertake medication review at any time [35].

• Funded by Government Medicare Benefits Schedule; maximum 1 review in 12 month period.

• Undertaken by county council employed pharmacists undertaken at any time, at least once a year, aiming to increase quality of medications and reduce PIMS [36].

  1. ACF aged care facility, GP general practitioner, GPwSI ACF GPs with special interest in aged care facilities, LGPT longitudinal general practice team