Summary

This book brings 10 years of data together from the BEACH (Bettering the Evaluation And Care of Health) program, to provide a reference document for those interested in changes that have occurred over the decade 2000–01 to 2009–10 in the GPs, the patients they see, the problems managed and the treatments they provide.

BEACH is a continuous national study of general practice in which data are collected from a new sample each year of about 1,000 GPs. Each GP provides details for 100 consecutive GP–patient encounters. BEACH began in April 1998, and this report uses data collected between April 2000 and March 2010 inclusive, from about 9,842 GP participants, covering 978,263 (weighted) GP–patient encounters.

Changes in the population influence GP clinical work. In June 2009, the population of Australia was estimated to be 22.2 million people. Like the rest of the developed world, Australia has an ageing population. Between 30 June 1989 and 30 June 2009, the proportion of people aged 65 years and over increased from 11% to 13% and the proportion aged 85 years and over more than doubled from 0.9% to 1.8%. The proportion aged less than 15 years decreased from 22% to 19%. As life expectancy improves, people are living longer with disease, so that a greater part of the GP workload will involve management of older patients with multiple chronic diseases.

From March 2008 to April 2009, there were about 116.8 million general practice consultations paid for by Medicare (up from 101 million in 2000–01), an average of 5.3 services per person. This is about the same level as in 2000–01, after a decrease in attendances in the mid-decade.

The GP participants

The largest changes in the characteristics of the GP participants over the 10 years were:

  • a 70% increase in the proportion of GPs who hold the Fellowship of the Royal Australian College of GPs (from 32% to 54%), reflecting the requirement (introduced in 1995) for Fellowship to become a recognised general practitioner
  • the move away for solo practice (down from 19% to 9% of GPs) to working in large practices with 10 or more GPs (up from 10% to 20% of participants)
  • a significant and large decrease, from 46% to 29%, in the proportion of GPs working in practices that provide their own after-hours patient care either completely or partially.

Who goes to the GP and why?

  • Over the study period the proportion of encounters with patients aged less than 45 years decreased from 51% to 44%, while the proportion with patients aged 45 years and over increased from 49% to 56%. Taking into account the increased number of encounters that now occur nationally, the number of encounters per annum with younger patients only increased by 190,000 while the number of encounters with older patients increased by about 16 million over the decade.
  • In 2008–09 and in 2009–10, patients who were new to the practice (not seen before) accounted for a significantly smaller proportion of encounters than in all earlier years, suggesting improving continuity of care.
  • There was no change in the proportion of encounters that were accounted for by Aboriginal and Torres Strait Islander people or by those who speak a language other than English as their primary language at home.
  • Compared with 2000–01, in 2009–10 patients presented to their GP with an increased number of reasons for their encounter. This increase is probably related to the increasing proportion of encounters that are with older people who are more likely to visit for multiple chronic disease management.
  • Over the decade there was a significant decrease in the rate at which patients presented with reasons for encounter describing symptoms and complaints, particularly back complaint, throat complaint, rash, abdominal pain, headache, ear pain, chest pain, dizziness, leg/thigh complaint, vomiting, and neck complaint.
  • In contrast, there were significant increases in the rates of requests for test results (almost doubling), immunisation/vaccination (up 48%), prescriptions (up by 26%), administrative procedures (doubling) and referrals (up 150%). The increase in requests for test results ties in with the increase in pathology and imaging testing over the decade.

Have the problems that GPs manage changed?

Compared with 2000-01, for every 100 patient encounters in 2009–10, GPs:

  • managed more problems (153 compared with 145 per 100 encounters), with fewer encounters involving one problem and more involving three or four problems, and it is estimated that this change, combined with increasing attendances, resulted in 34 million more problems being managed at GP encounters nationally in 2009–10 than in 2000–01
  • managed more newly diagnosed problems (59 compared with 47 per 100 encounters)
  • managed more chronic problems (54 compared with 48 per 100 encounters).

Problems related to the respiratory system remained the most frequently managed through the decade, but their management rate decreased significantly from 23 per 100 encounters in 2000–01 to 20 per 100 in 2007–08, and then increased to 22 in 2009–10. The recent rise may be related to concern regarding H1N1 influenza during 2009. The most common problems managed in general practice over the decade were

hypertension, immunisation/vaccination, check-up, upper respiratory tract infection, and depression. The management rate of general check-up almost doubled over the decade. The most common chronic problems managed were non-gestational hypertension, depressive disorder, chronic arthritis, non-gestational diabetes and lipid disorders. Management of depressive disorders increased significantly over the decade from 3.6 to 4.2 per 100 encounters, representing 1.3 million more occasions on which GPs managed depressive disorder in 2009–10 than a decade earlier.

How has general practice management changed?

Since 2000–01, some trends emerged in management of actions at patient encounters. The major changes, between 2000–01 and 2009–10, are described below.

  • The rate at which medications were prescribed, GP supplied or advised for purchase, decreased, from 75 per 100 problems in 2000–01 to 70 per 100 problems in 2009–10.
  • The rate at which medications were prescribed fell from 64 per 100 problems managed to 54 per 100 in 2009–10, so that (on average) 10 fewer prescriptions were being written for every 100 problems managed in 2009–10 than 10 years earlier. However, in 2009–10,  16.2 million (16%) more encounters were claimed through Medicare than in 2000–01. As a result, the extrapolated national effect of this change is 4.5 million more prescriptions given by GPs in 2009–10 than in 2000–01. If the estimated 23% increase over the 10 years in number of problems managed nationally is considered, the increase in prescriptions would have been 21.5 million if not for the lower GP prescribing rates. While the prescribing rate of many drug groups decreased, some drug groups increased, including: medications to reduce blood pressure, lipid (cholesterol) lowering agents, psychoanaleptics (paralleled by a decrease in psycholeptics) and antithrombotics (such as preventive aspirin).
  • There was a significant decrease in the proportion of prescriptions with 1–4 repeats ordered, and a significant increase (from 27% to 36%) in the proportion with five repeats.
  • Frequency of GP provision of clinical treatments (such as advice, health instruction and counselling) decreased from 26 per 100 problems to 23 per 100. This was particularly apparent in decreases in advice and education about treatment, and counselling and advice about nutrition and weight, and about exercise.
  • There was an increase in the rate at which procedural treatments were undertaken, from 8 per 100 problems to 11 per 100 problems. This was reflected in increased rates of local injections (other than vaccines), and in use of dressings/pressure/compression.
  • Referrals to other health providers significantly increased, from 7 to 9 per 100 problems, largely due to a significant increase in referrals to allied health services (from 1.6 to 2.6 per 100), with only a marginal increase in referrals to specialists (from 5.1 to 5.5).
  • The number of pathology tests/batteries ordered increased significantly by 43%, from 21 to 29 orders per 100 problems.
  • Orders for imaging tests also increased, from 5.3 per 100 problems to 6.4 per 100.

Patient risk factors

Among annual sub-samples of more than 30,000 adult patients aged 18 years and over:

  • prevalence of obesity rose significantly from 20% in 2000–01 to 26% in 2009–10, and prevalence of overweight was steady at about 34%
  • prevalence of daily smoking decreased from 19% to 15%
  • prevalence of at-risk alcohol consumption remained static at 26%.

In annual subsamples of more than 3,000 children aged 2–17 years, the prevalence of overweight and obesity remained static at about 10–11% obese and 17–18% overweight.

Are GP consultations getting shorter or longer?

In annual subsamples of measured (in minutes) consultation length of about 35,000 Medicare/DVA claimable consultations, there was no significant change in the mean length of consultation, sitting at about 15 minutes. The median length of consultations was 13 minutes in all years except 2003–04 and 2009–10, when it was 14.0 minutes.

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