Review and evaluation of Australian information about primary health care

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Summary

Primary health care is the cornerstone of the Australian health-care system, and general practice is its central component. It is vital, therefore, that accurate, reliable and timely information is available to assess the quality, effectiveness and outcomes of services provided in general practice. Such information is essential for:

• determining the need for services
• highlighting inequities in access and outcomes
• assessing the uptake of best-practice guidelines and evidence-based practices
• evaluating the outcomes of interventions
• providing practitioners with evidence for clinical decision making
• informing policy and strategy development.

Although several Australian collections contain information relevant to general practice, the extent and usefulness of these data for meeting priority information needs is variable. In order to improve the data environment, take advantage of advances in information technology and build on the capabilities of existing data collection systems, we need to take stock of what exists now, consider what is needed for the future, and determine the most effective and efficient ways of moving forward.

This report provides a review and evaluation of current data collections and methods. The evaluation considers not only the quality and breadth of the data items collected, but also looks more broadly at the usefulness of the data with regard to meeting the information needs of stakeholders. The report highlights gaps and limitations in the currently available data, and suggests strategies for improving the quality and usefulness of information about general practice in Australia. In addition, it outlines methods currently being used to collect general practice data electronically, and establishes options for further investigation.

Main findings

Usefulness of existing collections

• Data that are able to be used to build a comprehensive picture of the care provided in general practice are limited.
• At the national level, ‘quality’ is currently only able to be assessed in specific circumstances and for particular health conditions (for example, tracking the annual cycle of care for diabetes).
• To enable thorough investigation of general practice care, data should:
  • be able to be analysed at the individual patient level
  • link each management action (such as a prescription, clinical procedure, pathology or imaging request) to a diagnosis or symptom pattern
  • be able to be linked to allow tracking of presenting problems and management actions over time and to examine patient outcomes.

Options for future collection of general practice data

• Several collections use electronic methods to collect data from or about general practice. These include CONDUIT (Collaborative Network and Data Using IT), GPRN (the General Practice Research Network), the Australian Primary Care Collaboratives, ASPREN (the Australian Sentinel Practices Research Network) and the GP Census.
• The types of electronic methods in use by CONDUIT and GPRN appear to be useful starting points for exploring a national electronic data collection (though some important limitations need to be overcome).
• The CONDUIT system has great potential in that it enables linkage and transfer of clinical records between different health providers and services.
• The experiences and expertise of the groups involved in other collections, such as MEDIC-GP (Medical Enquiry Drug Information Centre—General Practice), BEACH (Bettering the Evaluation and Care of Health) and the Practice Health Atlas, can provide valuable insights to inform decisions about the way forward.
• Collections other than those containing GP–patient encounter data also provide useful information, such as patient satisfaction, functioning and quality of life, and reasons for seeking, or not seeking, care.
• Contextual information, such as workforce data and information about access to care, is necessary to aid interpretation of clinical data.

Enabling the transition to electronic collection

• There is a need for a set of principles around the collection and use of general practice data, covering implementation, data access and use, governance, and resourcing.
• Several important issues need to be tackled before electronic collection of general practice data could be implemented in Australia, including adoption of standards and resolution of legal and ethical issues (such as privacy and consent).
• Internationally, countries that have been more successful in introducing electronic patient records have been those that have had standards, protocols and infrastructure in place at an early stage.
• The low rate of uptake of electronic clinical record keeping in Australian general practices will limit the number of GPs able to participate in electronic data collection.
• GP groups expressed a willingness to participate in data collection, but need to be convinced of the usefulness of the data in terms of informing policy decisions or improving health outcomes or practices.

Recommendations

• A minimum data set specification for GP–patient encounters should be defined, in consultation with all stakeholders, which builds on work already undertaken in this area.
• The options established as potential starting points for an electronic collection should be explored with all stakeholders to formulate an agreed approach for implementing collection of this minimum data set at the national level.
• Where existing collections provide useful data, they should continue to be supported during the transition period and, where appropriate, afterwards.