General practitioners (GPs) provide most Australians with the majority of their primary health care—for example, in 2016–17, about 4 in 5 (83%) Australians aged 15 and over reported that they had consulted a GP at least once in the previous 12 months (ABS 2017). The GP is often a person’s first contact with the health system and, as such, the patient-GP relationship is crucial in delivering quality, coordinated care across a person’s life. This relationship is the cornerstone of patient-centred care—a model of health care that is ‘respectful of, and responsive to, the preferences, needs and values of patients’ (ACSQHC 2010).
The Coordination of Health Care Study was developed by the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS) to provide information on patients’ experiences of coordination and continuity in care across Australia. Coordination of care has been defined as ‘the deliberate organisation of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services’ (Victorian Department of Health and Human Services 2018).
The first part of the study is the 2016 Survey of Health Care, which aimed to provide new insights into the experiences of patients with coordination and information sharing about their care across different parts of the health system. The survey focused on Australians aged 45 and older who had seen a GP in the previous 12 months (as these Australians are the most likely to have experiences across many parts of the health system).
Of the questions asked in the survey, those relating to GP care in 2016 are most relevant to this report. Patients were asked if they had a usual GP or a usual place of care (Box 1.1), and how they would rate the overall quality of health care they received from their usual GP or place of care. They were also asked about factors that contribute to patient-centred care—including how often their usual GP or others in their usual place of care:
- involved them in decisions
- asked them about things in their work or life that affect their health
- explained test results.
As well, patients were asked if they felt comfortable talking with their usual GP or others in their usual place of care about personal problems related to their health.
Future AIHW publications from the Coordination of Health Care Study will explore the attributes of accessibility, coordination and comprehensiveness of care with a usual GP or in a usual place of care.
Box 1.1: What is a ‘usual GP’ and ‘usual place of care’?
A ‘usual GP’ is the GP whom a person visits for most of their health care.
A ‘usual place of care’ is the usual place that people go to if they are sick or need advice about their health. Examples of usual place of care settings include a clinic with GPs only or with GPs and other health professionals, a community health centre, an Aboriginal Medical Service, or (for some patients) a hospital emergency department (ABS 2016).
Ongoing relationships with a usual GP or place of care
Access to well-coordinated and good-quality health care is critical to enhancing patients’ understanding, control and self-management of their illness (Bywood et al. 2011; Jeon et al. 2010). This can be supported by ongoing patient relationships with a usual GP or usual place of care. Ongoing relationships can foster a deep knowledge of the patient, and connect past and future care—thus providing patients with a sense of predictability and coherence in care (Haggerty et al. 2003). Care continuity with providers who ‘know’ a patient facilitates patient-centred care; that is, care that accounts for patients’ needs, preferences, and the important role that patients play as active participants in their care (Singer et al. 2013).
Currently, in Australia, limited data are available on how different components of coordination and continuity are related to patients’ patterns of contact with primary care providers, or how these components may relate to patients’ outcomes. The Coordination of Health Care Study was developed to fill this gap (Box 1.2).
Box 1.2: About the Coordination of Health Care Study
The Coordination of Health Care Study was developed to fill an important information gap relating to patient experiences of coordination of care across Australia. It examines coordination and continuity of care in detail and will provide nationally consistent and local-level information on experiences with health care providers, using patient-reported information and administrative data. One part of the study was the 2016 Survey of Health Care. The survey’s scope, exclusions, sample selection and survey response are summarised in Figure 1.1.
Figure 1.1: Summary of 2016 Survey of Health Care participant selection and data collection
Scope (n=8.8 million)
Adults aged 45 and over who visited a GP between November 2014 and November 2015 (sample frame: Medicare Enrolment Database, or MEDB) (around 94.5% of adults aged 45 and over)
- people not registered with Medicare
- people who had only had GP transactions that were not billed through Medicare (for example, through doctors who draw a salary and do not bill Medicare)
- people who were active in military service and obtained all their medical services through the military.
Sample selection (November 2015) (n = 124,072)
Sample selected based on the following strata:
- age groups (5-year groups from age 45 to 79, then age 80 and over)
- sex (male and female)
- Primary Health Network (PHN) area (31 PHNs plus an extra category for unknown PHN)
- socioeconomic category (people were divided into 3 socioeconomic strata—‘low’, ‘medium’ and ‘high’ based on their postcode’s score on the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD))
- number of GP visits in the 12 months before selection (split into users with 1 to 11 visits and users with 12 visits or more).
Data available for analysis (collected in field April 2016 to June 2016)
(n = 35,495) (response rate = 28.6%)
Survey respondents reported their use of and experiences with care during the preceding 12 months (April–June 2015 to April–June 2016).
ABS data processing
To ensure representative analysis of survey data, data collected in the field were weighted and calibrated to population benchmarks before survey estimates were made.
The 29% survey response rate means that report findings may be subject to non-response bias (that is, survey respondents and non-respondents may differ with respect to their use of and experiences with GP care). Though it is not possible to reliably quantify this potential non-response bias, it may limit the generalisability of report findings. Some of the known characteristics that vary between the survey sample and the total in-scope population have been accounted for by weighting of estimates; however, this method cannot account for unmeasured biases (for further information on study limitations see Strengths and limitations).
The survey was designed to provide robust estimates for each of the 31 PHN areas. It over-sampled those who had seen a GP 12 or more times in the previous 12 months to ensure valid estimates for people with high health care needs. These people are more likely to have complex and chronic conditions, and have experiences with multiple health care providers, including hospitals, specialists and allied health professionals.
Purpose of this report
This is the first report to look at variation across PHN areas in Australia using data from the 2016 Survey of Health Care. It examines ongoing relationships between patients and their usual GP or place of care and explores patient-reported experiences in these primary care settings.
The survey and its sampling approach were specifically designed to allow for exploration of coordination of care at the PHN area level. PHNs were established with the key objective of the efficiency and effectiveness of the health system and improving coordination of care to ensure that patients ‘receive the right care in the right place at the right time’ (Department of Health 2016).
All information in this publication refers to people aged 45 and over who had at least one GP visit in the 12 months between November 2014 and November 2015. Their self-reported use of and experiences with GP care relate to care received during the reference period 2015–16. We refer to these people as ‘patients’ throughout this publication.
The key questions covered in this report are:
- How do patients aged 45 and over use GP care?
- How does patient use of GP care vary across PHN areas?
- How do patient-reported experiences of GP care vary across sociodemographic groups?
- How do patient-reported experiences of GP care vary across PHN areas?
- Does the type of usual place in which patients receieve care affect their perceived experiences of patient-centred care?
Structure of this report
- Ongoing relationships with a usual GP or usual place of care presents information on ongoing relationships between patients and their usual GP or place of care, including the proportion of patients who have a usual GP or place of care across sociodemographic groups and different geographical areas.
- Experience of patient-centred care presents information on patient-reported experience measures associated with patient-centred care and describes how these measures vary across sociodemographic groups and different geographical areas.
- Care settings and patient-reported experiences of care explores the patient-reported experiences of care across different types of usual place of care.
- Strengths and limitations discusses some of the strengths and limitations associated with report analyses.
- Next steps presents the ‘next steps’ expected to follow after this report from the Coordination of Health Care Study.