Summary

Note on data

The BEACH data contained in this report was collected by the Family Medicine Research Centre of the University of Sydney in collaboration with the AIHW. On 30 June 2011, the AIHW ceased its involvement in the BEACH program and ceased publishing annual BEACH reports. The survey continues to be run and the results are now published by the University of Sydney. The most recent annual reports can be found at  http://ses.library.usyd.edu.au/handle/2123/7771.

Summary

This report describes general practitioner (GP) clinical activity from April 2008 to March 2009 inclusive. It summarises results from the 11th year of the Bettering the Evaluation And Care of Health (BEACH) program, using a sample of 101,100 patient encounters with 1,011 GPs.

BEACH is a continuous cross-sectional national study of general practice activity that began in April 1998. Every year approximately 1,000 randomly selected GPs participate. Each GP records details of 100 consecutive patient encounters on structured paper recording forms, and provides information about themselves and their practice. The age–sex distribution of patients at the sampled encounters has excellent precision with all Medicare GP-claimed encounters.

Smaller studies are done in subsamples of encounters. Results for patient body mass index, smoking status and alcohol consumption are reported and Abstracts are provided in this report for results of other substudies finalised in 2008–09.

A web-based summary report of data from the last 10 years of BEACH highlighting major changes over that time, General practice activity in Australia 1999–00 to 2008–09: 10 year data tables.

The general practitioners

Of the 1,011 GP participants in 2008–09:

  • two-thirds were male, 46% were aged 55 years and over, 74% had graduated in Australia
  • 12% worked less than 6 clinical sessions and 10% worked 11 sessions or more per week
  • 40% had Fellowship of the Royal Australian College of General Practitioners
  • 24% conducted some consultations in a language other than English
  • 95% used a computer for some clinical purpose(s), four out of five produced prescriptions electronically, and over 50% of GPs reported using paperless medical records
  • 85% worked in an accredited practice and 55% in a teaching practice
  • 43% worked in practices of 2–4, and 29% in practices of 5–9 full-time equivalent GPs
  • 68% worked in a practice that employed a practice nurse(s)
  • 43% worked in practices providing their own/cooperative after-hours patient care.

The encounters

  • Direct encounters (patient was seen by the GP) accounted for 98.6% of all encounters.
  • About 97% of all direct encounters were claimable either through Medicare or the DVA.
  • The measured mean length of MBS/DVA-claimable encounters in 2008–09 was
  • 14.6 minutes and the median length was 13.0 minutes.

The patients

  • Patients aged less than 25 years accounted for 20% of encounters; 25–44 year olds 21%; 45–64 year olds 29%, and patients 65 years and over 30% of encounters.
  • Females accounted for 58% of encounters, and new patients to the practice 6%.
  • Half the encounters were with patients who held either a Commonwealth concession card (46%) or a Repatriation health card (3%).
  • At 1% of encounters the patient identified as an Aboriginal and/or Torres Strait Islander person and at 10% the patient was from a non-English-speaking background.
  • At 57% of encounters only one reason for encounter (RFE) was recorded, at 30.3% two RFEs were recorded and at 13% of encounters three RFEs were recorded.
  • Of the top 30 most common RFEs, 19 were descriptions of symptoms such as cough, throat and back complaints, and rash. However, four of the top five RFEs were requests for check-ups, prescriptions, test results and immunisations, and together these RFEs accounted for a quarter of all RFEs.

Problems managed

On average GPs managed 1.5 problems per encounter, the number per encounter increasing with patient age. The most common problems managed were:

  • respiratory problems (21 per 100 encounters)—in particular upper respiratory tract infection, respiratory immunisations, acute bronchitis and asthma
  • cardiovascular problems (such as hypertension and cardiac check-ups)
  • musculoskeletal problems (such as arthritis and back complaints)
  • problems of a general and unspecified nature (such as immunisations and check-ups)
  • skin problems (such as contact dermatitis and solar keratosis/sunburn).

Chronic conditions made up 36% of all problems managed, the most common being non-gestational hypertension (18% of chronic conditions), depressive disorder (8%), non-gestational diabetes (7%), lipid disorders (7%), and chronic arthritis (7%).

Management actions

For an ‘average’ 100 GP–patient encounters, GPs recorded 106 medications, 34 clinical treatments, 17 procedures, 9 referrals to specialists and 4 to allied health services, and ordered 46 pathology and 10 imaging tests.

Medications

  • 81% of all medications were prescribed, 10% were supplied to the patient by the GP and 8% were recommended by the GP for purchase over the counter.
  • No prescription was given for 55% of all problems managed, one was given for 37%, two for 6%, and more than two for 2%.
  • Medications most often prescribed were the anti-infectives amoxycillin (4% of all prescriptions), amoxycillin (3%) and cephalexin (3%); the analgesics paracetamol (3%) and paracetamol/codeine (2%); and the lipid modifying agent atorvastatin (2%).

Other treatments

  • There were 51 other treatments per 100 encounters, two-thirds being clinical treatments (34 per 100 encounters), and one-third procedures (17 per 100).
  • Preventive clinical activities (7 per 100 encounters) included counselling about nutrition and weight, and counselling/advice for exercise, smoking, prevention and alcohol.
  • Psychological counselling was provided at a rate of 3 per 100 encounters
  • Of the procedures, excisions/biopsies were the most frequent (3 per 100), followed by dressings and local injections (both 2 per 100) and incisions (1 per 100).

Referrals and admissions

  • The patient was referred at 13% of all encounters. Two-thirds of referrals were to specialists, 28% to allied health services and <1% to hospitals or emergency departments.
  • Referrals to specialists (9 per 100 encounters), were most often to surgeons (10%), ophthalmologists (9%), orthopaedic surgeons (9%) and dermatologists (8%).
  • Referrals to allied health services (4 per encounters) were often to physiotherapists (34%), psychologists (19%), podiatrists (9%) and dietitians or nutritionists (7%).

Tests and investigations

Pathology: At least one pathology test order was recorded at 18% of encounters (for 14% of problems managed). Chemistry tests accounted for more than half of all orders, the most common measuring lipids (4.8 orders per 100 encounters), EUC (3.4), liver function (3.3), and glucose/glucose tolerance (2.7 per 100 encounters).

Imaging: At least one imaging tests was ordered at 9% of encounters (for 6% of problems managed). Diagnostic radiology accounted for almost half of these and ultrasound for 37%.

Practice nurse activity

  • Practice nurses were involved in 6%of encounters and 4% of all problems managed.
  • Practice nurse activities were mainly procedural (93%) and these procedures represented 30% of all procedures recorded. Clinical treatments accounted for 7% of practice nurse activity, but the practice nurse provided less than 2% of all recorded clinical treatments.
  • The most common procedures done by practice nurses were injections (37% of their recorded procedures), dressings (21%), incisions (7%), INRs (6%) and check-ups (6%).
  • At 61% of encounters involving the practice nurse, no practice nurse Medicare item was recorded as claimable. The most commonly recorded item was for immunisation (64%).

Patient risk factors

Overweight and obesity in adults: In the sample of 33,526 patients, 25% were obese and 36% overweight. After adjusting for age–sex attendance patterns, prevalence in the attending adult population was 25% obese, 35% overweight, 38% normal and 2.4% underweight.

Overweight and obesity in children (2–17 years): Of 2,970 children, 27% were overweight (17%) or obese (11%). There was no difference in prevalence of overweight/obesity among male (29%) and female children (26%).

Smoking status: Of 34,194 adult patients, 15% were daily smokers (18% of males and 13% of females), but after adjustment for age–sex attendance patterns, an estimated 19% of the population attending general practice were daily smokers.

Alcohol consumption: One-quarter of 33,347 adult respondents reported drinking at-risk levels of alcohol. After adjustment for attendance rates, prevalence of at-risk drinking among the adult population attending general practice was 29%.