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released: 8 Dec 2010 author: Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O'Halloran J, Fahridin S media release

This report presents results from the twelfth year of BEACH program, a national study of general practice activity. From April 2009 to March 2010, 988 general practitioners recorded data about 98,800 GP-patient encounters involving the management of 155,373 problems. For an 'average' 100 encounters, GPs recorded 107 medications, 35 clinical treatments, 18 procedures, 9 referrals to specialists and 4 to allied health services, and ordered 45 pathology and 10 imaging tests.

ISSN 1442-3022; ISBN 978-1-74249-079-3; Cat. no. GEP 27; 216pp.; $28.00

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Note on data

The BEACH data contained in this report was collected by the Family Medicine Research Centre of the University of Sydney in collaboration with the AIHW. On 30 June 2011, the AIHW ceased its involvement in the BEACH program and ceased publishing annual BEACH reports. The survey continues to be run and the results are now published by the University of Sydney. The most recent annual reports can be found at http://ses.library.usyd.edu.au/handle/2123/7771.

Summary

This report describes clinical activity at, or associated with, general practitioner (GP) encounters, from April 2009 to March 2010 inclusive. It summarises results from the 12th year of the Bettering the Evaluation And Care of Health (BEACH) program, using a sample of 98,800 patient encounters with 988 GPs. After weighting for GP Medicare Benefits Schedule (MBS) claims activity and variations in GP characteristics of the final sample compared with the sample frame, 101,349 encounters were analysed in this report.

BEACH is a continuous cross-sectional national study of general practice activity that began in April 1998. Every year approximately 1,000 randomly selected GPs participate. Each GP records details of 100 consecutive patient encounters on structured paper recording forms, and provides information about themselves and their practice. The age–sex distribution of patients at the weighted encounters has excellent precision with that of patients at all Medicare GP-claimed encounters.

Smaller studies are done in subsamples of encounters. Results for patient body mass index, smoking status and alcohol consumption are reported and abstracts are provided with results of other substudies finalised in 2009–10.

A web-based summary report of data from the past 10 years of BEACH highlighting major changes over that time, General practice activity in Australia 2000–01 to 2009–10: 10 year data tables.

The general practitioners

Of the 988 GP participants in 2009–10:

  • 44% were female; 35% were aged 55 years and over and 7% were aged less than 35 years
  • 71% had graduated in Australia
  • 11% averaged less than 21 hours per week in direct clinical patient care, 56% 21–40 hours and 33% more than 40 hours per week
  • 54% were Fellows of the Royal Australian College of General Practitioners
  • 24% conducted some consultations in a language other than English
  • 98% used a computer for some clinical purpose(s); 85% produced prescriptions electronically, and 72% were receiving pathology results on line; almost two-thirds (64%) reported having paperless medical records
  • 91% worked in an accredited practice and 65% in a teaching practice
  • 41% worked in a practice with 5–9 individual GPs—the most common practice size— and 29% in a practice with 5–9 full-time equivalent GPs
  • 79% worked in a practice that employed one or more practice nurses
  • 49% had a pathology collection centre, 44% a psychologist, and 29% a physiotherapist, located within 50 metres of the practice
  • 45% worked in a practice providing its own/cooperative after-hours patient care.

The encounters

  • Direct encounters (patient was seen by the GP) accounted for 98% of all encounters, and the vast majority (97%) of direct encounters were claimable through either Medicare or the Department of Veterans’ Affairs (DVA).
  • Surgery consultations accounted for 93% of all MBS/DVA-claimable GP encounters, standard consultations being most common (82% of GP consultations). Home, residential aged care and hospital visits were few.
  • About 1% of encounters were claimable as GP mental health care items, and 1% as chronic disease management items. Health assessment and case conference were rare.
  • The measured mean length of MBS/DVA-claimable encounters was 15.3 minutes, and the median length was 14.0 minutes.

Who goes to see the GP?

  • Patients aged less than 25 years accounted for 21% of encounters, those aged 25–44 years for 23%, 45–64 years for 28%, and 65 years and over for 28%.
  • Females accounted for 57% of encounters.
  • At 8% of encounters the patient was new to the practice.
  • Almost half the encounters were with patients who held either a Commonwealth concession card (46%) or a Repatriation health card (3%).
  • At just over 1% of encounters the patient identified as an Aboriginal and/or Torres Strait Islander person, and at 9% the patient was from a non-English-speaking background.
  • For every 100 encounters, patients gave 155 reasons for encounter (RFEs): 65 symptoms/ complaints; 31 diagnoses/diseases; and 59 requests for services (such as, prescription).
  • The most common RFEs were requests for a check-up, prescriptions, and test results.

What problems do GPs manage at patient encounters?

On average, GPs managed 153 problems per 100 encounters, the number increasing with patient age, and being higher for females than males.

  • Problems managed most often were respiratory (22 per 100 encounters), of a general or unspecified nature (19), musculoskeletal (17) and cardiovascular (17).
  • The most common individual problems managed were hypertension (9 per 100 encounters), immunisation/vaccination (7), check-ups (7), upper respiratory tract infection (6), depression (4), arthritis (4) and diabetes (4).
  • New problems (39% of all problems) were managed at a rate of 59 per 100 encounters, the most frequently managed being upper respiratory tract infection (URTI), immunisation/vaccination and acute bronchitis.
  • Chronic conditions made up 35% of all problems managed, the most common being non-gestational hypertension (17% of chronic conditions), depressive disorder (8%), chronic arthritis (7%), non-gestational diabetes (7%), and lipid disorders (6%).
  • Work-related problems (1.6% of all problems) were managed at a rate of 2.5 per 100 encounters, with more than half of these related to the musculoskeletal system.

An example of the relationship between a problem managed and other data fields is given for GP management of back problems in 2009–10.

Management actions

For an ‘average’ 100 encounters, GPs recorded 107 medications (83 prescribed), 35 clinical treatments, 18 procedures, 8 referrals to specialists, 4 referrals to allied health services, and ordered 45 pathology tests/batteries and 10 imaging tests.

Medications

  • For every 100 problems managed, on average, 54 medications were prescribed, 9 were supplied by the GP and 6 were advised for over-the-counter purchase.
  • No prescription was given for 57% of all problems managed, one was given for 35%, two for 6%, and more than two for 2%.
  • Medications most often prescribed were: the antibiotics amoxycillin (4% of all prescriptions), cephalexin (3%) and amoxycillin with potassium clavulanate (2%); the analgesics paracetamol (3%) and paracetamol/codeine (2%); and the lipid modifying agent atorvastatin (2%).
  • Of the 64,718 prescriptions (77% of all prescriptions) where number of repeats was recorded, the GP specified no repeats for 34%, and five repeats for 36%.
  • Medications were supplied by the GP at a rate of 14 per 100 encounters, with vaccines accounting for almost two-thirds of these medications.
  • Medications were advised for over-the-counter purchase at a rate of 10 per 100 encounters; the most common were paracetamol and ibuprofen.

The pattern of GP prescribing of systemic antibiotics for the common cold (also known as URTI), other respiratory infections and other problems is presented as an example of pharmaco-epidemiological analysis of BEACH data.

Other treatments

There were 53 other treatments given by the GP per 100 encounters, or 34 per 100 problems managed, two-thirds being clinical treatments (35 per 100 encounters), and one-third being procedures (18 per 100).

Clinical treatments: The most frequently recorded clinical treatments were: general advice and education (4 per 100 problems); counselling about the problem (3 per 100); and advice and education about treatment (3 per 100).

Procedural treatments: The most frequently recorded procedures were excisions (2 per 100 problems), local injections (2 per 100), dressings (2 per 100) and incisions (1 per 100).

Referrals and admissions

There were 13 referrals made per 100 encounters, or 9 per 100 problems managed. Two-thirds (64%) of the referrals were to specialists, 29% to allied health services and less than 5% to hospitals or emergency departments.

  • Referrals to specialists (6 per 100 problems managed) were most often to surgeons (10%), orthopaedic surgeons (9%) ophthalmologists (8%) and dermatologists (8%).
  • Referrals to allied health services (3 per 100 problems managed) were most often to physiotherapists (29%), psychologists (20%), podiatrists (9%) and dentists (8%).

Tests and investigations

Pathology tests ordered: Tests were ordered at a rate of 45 per 100 encounters or 29 per 100 problems. Chemistry tests (17 tests/batteries per 100 problems) accounted for 58% of all orders. The most common individual tests were: full blood count, lipids, electrolytes, urea and creatinine; liver function; and glucose/glucose tolerance.

Imaging ordered: Imaging was ordered at a rate of 10 per 100 encounters and 6 per 100 problems managed. Diagnostic radiology accounted for 47% of these, and ultrasound 38%.

An example of the relationship of tests and investigations to other data elements is provided for computerised tomography scans of the lumbar and lumbosacral spine.

Practice nurse activity

  • Practice nurses were involved in 9% of encounters and 6% of all problems managed.
  • The majority of practice nurse activities were procedural (93%), and these procedures represented 40% of all procedures recorded. Clinical treatments accounted for 7% of practice nurse activity, but only 2% of all recorded clinical treatments.
  • The most common procedures done by practice nurses were injections (48% of their recorded procedures), dressings (15%), incisions (7%) and check-ups (7%).
  • For only 46% of encounters involving practice nurses was a practice nurse item number recorded as claimable, the most common item being for immunisation (75%).

Patient risk factors

Overweight and obesity in adults (18 years and over): In 31,932 sampled adults, 26% were obese and 34% overweight. After adjusting for age–sex attendance rates, prevalence in the attending adult population was 25% obese, 34% overweight, 2% underweight, and 38% normal.

Overweight and obesity in children (2–17 years): Of 3,183 sampled children, 28% were overweight (18%) or obese (10%). There was no difference in prevalence among male (28%) and female children (27%).

Smoking status (adults 18 years and over): Of 32,744 adult patients, 15% (18% of men and 13% of women) were daily smokers. After adjusting for age–sex attendance rates, an estimated 18% of the population attending general practice were daily smokers.

Alcohol consumption (adults 18 years and over): Of 31,771 adult patients 27% (32% of men and 23% of women) reported drinking at-risk levels of alcohol. After adjusting for attendance rates, prevalence of at-risk drinking among the adult population attending general practice was 30%.

Recommended citation

Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O'Halloran J, Fahridin S 2010. General practice activity in Australia 2009-10. General practice series no. 27. Cat. no. GEP 27. Canberra: AIHW.