GP consultations, management plans and medication reviews

GP-specific consultations

About half (49%) of all MBS services used by people with dementia were for GP consultations, with an average of 20 GP consultations used by each person with dementia in 2016–17 (Table S7.4). This includes dementia-specific consultations, as well as consultations to manage other health issues among people with dementia.

Irrespective of dementia status, people who were living in residential aged care had more consultations on average than those who were living in the community, likely due to people in residential aged care having more complex healthcare needs (Figure 7.4). 

Among people who were living in residential aged care, the number of consultations was similar for men and women:

  • women with dementia had 23 consultations on average compared with 25 consultations for men with dementia. Men and women without dementia both had 25 consultations on average.
  • the average number of consultations decreased with increasing age for men and women with and without dementia.

Among people who were living in the community:

  • men and women with dementia had on average 14 consultations each— this was more than men and women without dementia (7 and 8 consultations, respectively)
  • the average number of consultations increased with age, up to age 75–79 for people with dementia and age 85–89 for people without dementia, and then decreased. The increase was smaller among people with dementia (from 13 consultations in people aged 30–64 to 15 consultations in people aged 75–79) than people without dementia (from 7 consultations in people aged 30–64 to 14 consultations in people aged 85–89).

Figure 7.4: Average number of GP consultations for people with and without dementia, by sex, age and place of residence in 2016–17

Figure 7.4 is a bar graph showing the average number of GP consultations for people with and people without dementia in 2016–17 by sex, age and place of residence. Among people who were living in residential aged care, the number of consultations was similar for men and women with and without dementia. For people with dementia, there was an average of 25 consultations for men and 23 for women, compared with an average of 25 consultations each for men and women without dementia. The average number of consultations decreased with increasing age for men and women with and without dementia. In contrast, among those living in the community, men and women with dementia had a higher average number of GP consultations each (both 14) compared with men (7 consultations) and women (8 consultations) without dementia. For people living in the community, the average number of consultations increased with age, up to age 75–79 for people with dementia and age 85–89 for people without dementia but then declined.

Box 7.1: Assessment and management plans

As there are no specific MBS items for dementia diagnosis and management services, a number of MBS items may be claimed by GPs and other specialists for services involved in diagnosing and managing dementia including:

  • Geriatrician Referred Patient Assessment and Management Plans (MBS items 141–147; referred to as ‘Geriatrician referred plans’) are comprehensive assessment and management plan services provided by a consultant physician or specialist in geriatric medicine to patients who have been referred by a GP. These services are for patients aged 65 and over with complex health issues and who are at significant risk of poor health outcomes.
  • Chronic Disease Management Items (MBS group A15; referred to as ‘Chronic disease plans’) are management plan services for people with chronic or terminal health conditions, or conditions that require care from a GP and at least 2 other health or care providers.

These plans aim to provide comprehensive and up-to-date information on the patient’s health priorities, actions for patients to take to manage their condition/s and achieve their health goals, as well as information on health and community services available to the patient. In addition to assessing a patient’s current and past medical history, assessments may involve an assessment of physical, psychological (including cognition) and social function, as well as advanced care planning.

In 2016–17, on average there were substantially more geriatrician referred plans (17 per 100 people) and chronic disease plans (131 per 100 people) for people with dementia than people without dementia (1.4 and 55 per 100 people, respectively) (Figure 7.5).

These differences between people with and without dementia were mainly due to differences among people living in the community. On average there were:

  • 18 times as many geriatrician referred plans for people with dementia as there were for people without dementia living in the community
  • 2.7 times as many chronic disease plans for people with dementia as there were for people without dementia living in the community.

By comparison, there were 1.7 times as many geriatrician referred plans for people with dementia as there were for people without dementia living in residential aged care. However, the average number of chronic disease plans was slightly higher for people without dementia than people with dementia living in residential aged care.

Figure 7.5: Geriatrician referred plans and chronic disease plans for people with and without dementia (plans per 100 people), by place of residence in 2016–17  

Figure 7.5 is a bar graph showing the rate of geriatrician referred plans and chronic disease plans for people with and people without dementia (plans per 100 people) in 2016–17 by place of residence. There were substantially more geriatrician referred plans (17 per 100 people) and chronic disease plans (131 per 100 people) for people with dementia than people without dementia (1.4 geriatrician referred plans and 55 chronic disease plans per 100 people). These differences between people with and without dementia were mainly due to differences between people with and without dementia living in the community.

In addition to place of residence, age was a key driver in differences in the average number of geriatrician referred plans and chronic disease plans for people with dementia compared to people without dementia (Figure 7.6). The average number of geriatrician referred plans and chronic disease plans was higher at younger ages among people with dementia (highest among those aged 70–74) than among people without dementia (highest among those aged 85–89).

Geriatrician referred plans are largely provided to people aged 65 or over, however there were plans provided to people with and without dementia aged under 65. On average, people with younger onset dementia were 2.3 times more likely to have had a geriatrician referred plan than people without dementia aged under 65, suggesting these services were specific to managing their dementia. On the other hand, the average number of geriatrician referred plans was similar among people with younger onset dementia and people without dementia aged under 65 who were living in residential aged care (both had on average 1 geriatrician referred plan per 100 people).

This suggests that geriatrician referred plans are likely used in the early stages of diagnosis and management of dementia, where people with younger onset dementia are more likely to be living in the community.

Figure 7.6: Geriatrician referred plans and chronic disease plans for people with and without dementia (plans per 100 people), by age, sex and place of residence in 2016–17

Figure 7.6 is a bar graph showing the rate of geriatrician referred plans and chronic disease plans for people dementia with and people without dementia (plans per 100 people) in 2016–17 by sex, age and place of residence. The rate of chronic disease plans was similar across all ages for people with and without dementia living in residential aged care. However, among those living in the community and in younger age groups, rates of chronic disease plans were higher for people with dementia compared with people without dementia. A higher rate of people with dementia received geriatrician referred plans, compared to those without dementia. This difference was greater for younger ages and for those living in the community.

Medication Management Reviews

As people with multiple chronic health conditions may be prescribed a number of medications to treat these conditions, it is important that the number and type of medications prescribed is reviewed regularly by health professionals to prevent and monitor medicine interactions and adverse side effects. Medication management reviews are undertaken by GPs in collaboration with community pharmacists and specialists as well as in discussion with the patient and their carer.

In 2016–17, for every 100 people with dementia there was an average of:

  • 26 medication management reviews—this was 7 times higher than the average number of reviews for people without dementia (3.7 reviews)
    • this was driven by differences among people living in the community—people with dementia living in the  community had 3 times as many reviews (9.9 reviews) as people without dementia living in the                    community (3.5 reviews).
    • whereas this was similar for people with dementia (37 reviews) and people without dementia                    (38 reviews) living in residential aged care
  • 25 reviews for men and 27 reviews for women with dementia—by comparison this was 3.6 reviews for men and 3.8 reviews for women without dementia
  • 19 reviews for people with younger onset dementia (aged under 65) and this increased to 28–29 reviews among people aged 85 and over (Figure 7.7).

The vast difference in the average number of medication management reviews between people with and without dementia living in the community was seen in both men and women and across each age group. 

Figure 7.7: Medication management reviews for people with and without dementia (reviews per 100 people) by age, sex and place of residence in 2016–17

Figure 7.7 is a bar graph showing the rate of medication management reviews provided to people with dementia and people without dementia (reviews per 100 people) in 2016–17 by sex, age and place of residence. Overall, the rate of medication management reviews was substantially higher among people with dementia (26 reviews per 100) than among people without dementia (4 reviews per 100). Different rates of medication management reviews between people with and without dementia living in the community explains the majority of this difference, , as the rate of reviews was similar across age groups for people with and without dementia living in residential aged care. 

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