Changes in general practice activity—effects of an ageing population and changing health policies

A report released today by the Australian Institute of Health and Welfare and the University of Sydney examines changes in the clinical activities of GPs and management of disease over the last decade in the context of policy changes, changes in the GP workforce and the ageing population.

The report, General practice in Australia, health priorities and policies 1998 to 2008, focuses on the management of conditions declared as national health priority areas.

According to the report, GPs are spending an increasing proportion of their time with older patients and are managing more chronic diseases.

'The issues that patients bring to the doctor have both changed and become more complex over time,' said Dr Helena Britt of the Australian General Practice Statistics and Classification Centre, a collaborating unit of the Institute and the University of Sydney.

There are now more requests for services such as check-ups, and requests for prescriptions, and GPs are doing more checking and managing of chronic diseases such as diabetes, high blood pressure, high cholesterol and depression.

'The way general practice has changed over the last decade has brought some positive outcomes, including increased detection and management of Type 2 diabetes, more involvement in detecting and managing cancers and other chronic conditions,' Dr Britt said.

'Referrals to psychologists for psychological problems have increased, particularly since some consultations with psychologists became a Medicare item, but there has been no decrease in GP involvement in their management, which suggests more sharing of care between these professions,' she said.

Areas where there have been policy changes but no measurable change in GP behaviour in the last 10 years include management of arthritis and most other musculoskeletal conditions, and management of heart disease and stroke.

'However the lack of an increase in the GP management of stroke and arthritis in an ageing population does suggest better preventive care in these areas,' Dr Britt said.

The report raises some concerns about increasing frequency of adverse events due to drug side-effects, and the ever-increasing number of pathology tests being ordered. It also suggests that the under-identification of Aboriginal and Torres Strait Islander Australians in general practice settings is hindering the impact of policies aiming to improve the health of Indigenous Australians.

The BEACH (Bettering the Evaluation and Care of Health) program is a continuous national study (since 1998) based on data collected from about 1,000 GPs every year. This report uses data from 990,000 GP-patient encounters.


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