Primary health care services
Primary care is often the first contact a person has with the health system and can be delivered in a range of settings, by a range of providers. It may be provided by general practitioners (GPs) within general practice or in an aged care or community setting, or by public or private service providers.
Current and robust data on dementia-specific GP and community-based specialist services are a major data gap in Australia. Advances with data linkage now enable some examination of GP and other community-based medical specialist services utilised by people with dementia. This is possible by linking GP and specialist data with other datasets that have dementia diagnostic information.
Data in this section are sourced from linked health and aged care services data in the National Health Data Hub (NHDH 2021–22). Key data considerations are summarised below, please refer to the Technical notes for more information.
The following section presents data on the use of Medicare-subsidised (referred to as MBS – Medicare Benefits Schedule) primary care services in 2021–22 for people identified as having dementia in the linked data (referred to as ‘the NHDH dementia cohort’). Users can explore GP, nursing, specialist and allied health attendances.
For the underlying data presented in these pages, refer to the Primary health care services data tables.
While there is a lack of robust data on dementia-specific GP and community-based specialist services in Australia, the following data sources provide some insight on dementia-specific GP consultations:
- Bettering Evaluation of Care and Health survey (BEACH)
- NPS MedicineWise General Practice Insights report.
For more information on existing data gaps for dementia and future possibilities for filling in these gaps refer to the AIHW reports: Dementia data gaps and opportunities and the National Dementia Data Improvement Plan 2023–34.
The NHDH dementia cohort includes everyone with at least one of the following in the NHDH between 1 July 2016 to 30 June 2022:
- A dementia-specific medication dispensed through the PBS / RPBS.
- A principal or additional diagnosis of dementia in an emergency department (ED) presentation or hospital admission.
- A supplementary chronic code of dementia in a hospital admission.
- A record of dementia in datasets from the National Aged Care Data Clearinghouse (NACDC) including the Aged Care Assessment Program (ACAP) and National Screening Assessment Form (NSAF).
People recorded as having dementia as their underlying or additional cause of death between 1 July 2021 and 31 December 2022 were also included.
For these analyses, the NHDH dementia cohort was also restricted to people who had at least one Medicare Benefits Schedule (MBS) record during the 2021–22 financial year and to people who did not have missing age information.
The analysis focused on people with dementia identified in the linked data, the NHDH dementia cohort, who accessed at least one Medicare Benefits Scheme (MBS) service in the 2021–22 financial year.
The NHDH dementia cohort may not be representative of all people living with dementia in Australia, and their MBS service use may not be representative of MBS service use by all people living with dementia. Because dementia diagnoses are not recorded in MBS data, the NHDH dementia cohort are identified through their use of other health and aged care services. People with dementia who did not access these services or who were not identified as having dementia in the available data will not be included in the NHDH dementia cohort.
The NHDH dementia cohort also includes people who died due to or with dementia, and most deaths among people with dementia occur in permanent residential aged care. This is likely to influence patterns of MBS service use observed among this group. With the exception of the Pharmaceutical Benefits Scheme (PBS), NHDH data sources used to identify people with dementia predominantly reflect services used by people with more severe and progressed dementia.
For more information on place of death among people who died due to dementia, see Deaths due to dementia.
For more information on key data considerations of this analysis, refer to the Technical notes.
- Percentage of people who used a service: ‘Percentage’ is the proportion of people with at least one service recorded in the linked data in 2021–22. This is also referred to as a rate of service use.
- Average number of services per person: The average number of services per person was calculated for people who used the service at least once in 2021–22, referred to in the figures as ‘Mean (service users)’.
These measures reflect different aspects of access to services. For example, the proportion of our NHDH dementia cohort with one or more nurse and/or Aboriginal health care worker attendance was higher among those living in the community than those living in residential care. However, those living in residential care had on average 4 more nurse and/or Aboriginal health care worker attendances per person.
Profile of people with dementia who used an MBS service in 2021–22
In 2021–22, there were 253,000 Australians identified as having dementia in the linked data (referred to as ‘the NHDH dementia cohort’). Of these people, 51% lived in permanent residential aged care and 49% lived in the community. Most of the NHDH dementia cohort were women (64% of people in permanent residential aged care and 52% of people in the community).
It is known that the types and frequency of health services used change after a person enters permanent residential aged care. For example, general practitioner attendances increase, and specialist attendances decrease (AIHW 2022). For this reason, data in this section are presented separately by place of residence.
For detailed breakdowns of the age, sex and place of residence for people included in this analysis, see Table S7.1.
What MBS services were most commonly used by people with dementia?
GP attendances and pathology were the most common MBS services used by the NHDH dementia cohort in 2021–22, with each service accounting for 35% to 46% of services provided to people living in the community or in residential aged care (Figure 7.1). These MBS services were the most commonly used services by people with dementia within each sex and age group for both people living in the community and living in permanent residential aged care.
Figure 7.1: MBS services provided to people with dementia in 2021–22: percentage by place of residence
The stacked horizontal bar chart shows the proportion of MBS services used in people with dementia comparing those living in the community and those living in residential aged care.
Note: The MBS service type ‘operations’ include anaesthetics, surgical operations and assistance at operations. For more information, refer to Technical notes.
Profiles of types of MBS service use
The NHDH dementia cohort living in the community used an average of 46 MBS services during 2021–22 compared to 53 services for the NHDH dementia cohort living in residential aged care.
The largest differences in rates of service use among the NHDH dementia cohort living in the community and in residential aged care was in specialist attendances (67% and 39%, respectively). There were also large differences observed among rates of diagnostic imaging (62% in the community and 33% in residential aged care), operations (32% in the community and 12% in residential aged care) and nurse and/or Aboriginal health worker attendances (27% in the community and 21% in residential aged care).
There were less distinct differences among those living in the community and in residential care in rates of allied health, general practitioner (GP), and pathology service use.
Most of the NHDH dementia cohort saw a GP, with 99% of the cohort living in the community and 98% of the cohort living in residential care. On average, the NHDH dementia cohort living in residential care attended the GP more (25 attendances per person) than those living in the community (16 attendances per person).
Figure 7.2 provides a detailed breakdown of the types of MBS services used in 2021–22, including GP, nursing, specialist, allied health, pathology and diagnostic imaging attendances.
Figure 7.2: MBS service use in people with dementia in 2021–22 by type of service, place of residence, sex and age
The vertical bar chart shows the MBS service use among people with dementia. The percentage of people who used a service, average number of services per person and total number of services are shown.
Managing dementia and other chronic conditions
As there are no specific MBS items for dementia diagnosis and management services, several MBS items may be claimed by GPs and other specialists for services involved in managing chronic or complex conditions, such as dementia. This includes chronic disease management plans and medication management reviews.
Chronic Disease Management services
Chronic Disease Management services are 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 and would benefit from a structured approach to their care. In 2021–22, they included the preparation, coordination and review of GP management plans, team care arrangements and multidisciplinary care plans.
These services aim to provide comprehensive information on the patient’s current 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 2021–22, half (48%) of the NHDH dementia cohort had a chronic disease management service. This was similar for people living in the community (47%) or in residential aged care (50%) (Table S7.2). For the NHDH dementia cohort living in the community, a higher proportion of those aged 75–84 had a chronic disease management service (50%) compared with younger or older people, with the lowest rates seen in those aged 95 and over (31%). For those living in residential aged care the proportion of the NHDH cohort who had a chronic disease management service was similar for those aged under 95 (around 50%) and lowest for those aged 95 and over (39%).
It should be noted that as people get older, some services, including allied health, can be accessed through My Aged Care which may mean less reliance on Chronic Disease Management items for older adults. This should be taken into consideration when comparing Chronic disease plans by age group.
Medication management reviews
Medication management reviews (MBS items 245–249; 900–903) are a category of service where GPs and pharmacists manage patient’s medications, supporting the quality and safe use of medicines.
In 2021–22, 1 in 6 (16%) people in the NHDH dementia cohort had a medication management review. This was much more common for those living in residential aged care (28%) compared with those living in the community (3%) (Table S7.2).
The proportion of the NHDH dementia cohort who accessed an MBS subsidised medication management review decreased slightly with age for those living in the community. There was no clear pattern by age for those living in residential aged care.
It should be noted that medication management reviews can also be conducted during a hospitalisation, and GPs can conduct medication management reviews as part of a chronic disease management service. These would not be captured here.
Improved post diagnostic care for people living with dementia and enhanced coordination of care are two key aims of the National Dementia Action Plan. As part of this work, the plan aims to increase the number of people living with dementia with chronic disease management services and regular medication reviews. Progress towards these aims is being monitored through the National Dementia Action Plan indicator dashboard.
AIHW (Australian Institute of Health and Welfare) (2020–21) National Health Data Hub, AIHW, Australian Government, accessed 10 February 2024.
AIHW (2022) Younger onset dementia: new insights using linked data, AIHW, Australian Government, accessed 22 February 2024.