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Healthy Communities: GP care for patients with chronic conditions in 2009–2013 - Report - Summary

Healthy Communities: GP care for patients with chronic conditions in 2009–2013

Summary

Chronic conditions are responsible for about 85% of the total burden of disease in Australasia.1 Conditions such as heart disease, diabetes and mental illness are among the top 10 causes of premature death.2 People with chronic conditions account for a large share of the 635,000 potentially avoidable hospitalisations in 2011–12.3

Worldwide, the number of people living with chronic health conditions is increasing and placing greater demands on health care systems.4,5

In local communities, health professionals play a critical role in assisting people in the management of their chronic conditions. Strong primary health systems are associated with better health outcomes, fewer hospital admissions and reduced health system costs.6

The Australian Government has announced that in 2015, Primary Health Networks (PHNs) will be established to better coordinate health services. PHNs are intended to ensure that patients, particularly those with complex chronic conditions, receive the right care, at the right place and right time.7 While doctors will be working towards the consistent delivery of appropriate care in line with recommended guidelines, opportunities may exist to optimise the management of chronic conditions.8–10

Accordingly, the aim of this report is to deepen understanding of how management of chronic conditions differs across local areas, and to support health professionals and PHNs, particularly GP-led Clinical Councils, target improvements in services to maintain people’s health and keep people out of hospital.

The report presents information on patients with one or multiple diagnosed chronic conditions, and focuses on patients with some of the most common conditions managed in general practice, including selected cardiovascular risk conditions, depression, anxiety, arthritis and chronic back pain.

This is the first report to give a local-level breakdown of the care of patients with chronic conditions by determining how many of these patients there are, how often and in what ways their GP manages these conditions.

Findings are described for 61 local areas and for seven clusters of similar areas called peer groups. Results are presented from data collected by the Bettering the Evaluation and Care of Health (BEACH) program, conducted by the University of Sydney, during the period from 2005 to 2013.

Key findings

Marked differences were found in both the frequency with which GPs manage patients’ chronic conditions and in the clinical actions GPs take to care for those conditions.

Among all people who visit the GP at least once in a year, the percentage of people with one or more selected chronic conditions ranged from 44% to 56% across local areas. The percentage was slightly higher in regional areas, particularly in lower-income regional areas, than in metropolitan areas.

In comparison, the percentage of all GP consultations that involved patients who had one or more selected chronic conditions was only slightly higher (51% to 60%) across metropolitan and rural areas, and higher still (60% to 66%) across regional areas.

Across local areas, the percentage of all GP consultations in which one or more chronic conditions was actively managed ranged from 34% of GP consultations in Sydney North Shore & Beaches to 50% of consultations in Hume (Vic/NSW) (Figures 3a and 3b).

The findings also indicate that irrespective of variation in how often GPs saw patients with three or more chronic conditions (19% to 30% of consultations across peer groups), they actively managed three or more chronic conditions at about the same frequency (2% to 3% of consultations). This indicates that in local areas with a higher proportion of patients with three or more chronic conditions, opportunities may exist to optimise care for these patients.

The percentage of all GP consultations in which chronic conditions were actively managed differed, depending on where the GP practises:

  • GP management of selected cardiovascular risk conditions ranged from 5% to 11% across local areas nationally
  • GP management of depression or anxiety ranged from 4% to 9% across local areas nationally
  • GP management of arthritis or chronic back pain ranged from 3% to 7% across local areas nationally.

Depending on where a GP practises, the approach they take to actively manage their patients’ chronic conditions also differs:

  • In managing selected cardiovascular risk conditions:
    - Statins were prescribed on 26% to 40% of GP management occasions across local areas nationally. Current guidelines recommend that most patients with these conditions should be treated with statins10
    - A referral to another health professional was provided on 4% to 11% of occasions across local areas.
  • In managing depression or anxiety, diverse approaches taken may reflect the availability of allied health professionals and specialists:
    - A psychotropic medication (such as an antidepressant, antipsychotic or sedative) was prescribed on 38% to 74% of GP management occasions across local areas
    - GP counselling was provided on 25% to 51% of occasions across local areas
    - A referral to another health professional was provided on 11% to 21% of occasions across local areas.
  • In managing arthritis or chronic back pain:
    - A medication was prescribed on 52% to 75% of GP management occasions across local areas
    - A referral to another health professional was provided on 11% to 22% of occasions across local areas
    - Imaging was ordered on 8% to 20% of occasions across local areas, despite current guidelines discouraging imaging for the management of chronic low back pain.11

GP care for patients with selected cardiovascular risk conditions

Among all people who visit the GP at least once in a year, the percentage of people who had a selected cardiovascular risk condition ranged from 17% to 19% in metropolitan areas, and from 16% to 21% in regional and rural communities.

The percentage of all GP consultations that were with patients who had a cardiovascular risk condition, irrespective of whether the condition was managed, was 22% in high-income and middle-income metropolitan areas. It ranged from 19% to 30% in lower-income metropolitan and all regional and rural areas.

GPs managed cardiovascular risk conditions in about one-third of all the consultations with these patients. The proportion of all GP consultations in which a cardiovascular risk condition was actively managed ranged from one in 20 (5%) consultations in South Eastern Melbourne and West Moreton-Oxley (Qld) to one in nine (11%) consultations in Hume (Vic/NSW).

GP actions in the management of cardiovascular risk conditions also varied across local areas. Depending on where a GP practises, the percentage of GP management occasions in which statins were prescribed ranged from 26% to 40% and a referral to another health professional from 4% to 11% across local areas.

(Figures 4 to 7)

GP care for patients with depression and anxiety

Among all people who visit the GP at least once in a year, the percentage of people who had depression, anxiety or both of these conditions ranged from 16% to 18% in metropolitan areas and from 13% to 20% in regional and rural communities.

The percentage of all GP consultations that were with patients who had depression, anxiety or both of these conditions, irrespective of whether these conditions were managed, ranged from 18% to 21% in metropolitan, 20% to 23% in regional, and 15% to 18% in rural communities.

GPs managed depression or anxiety in about one-third of all the consultations with these patients. Across local areas, the proportion of all GP consultations in which depression or anxiety were actively managed ranged from one in 25 (4%) consultations in Sydney North Shore & Beaches to one in 11 (9%) consultations in Frankston-Mornington Peninsula (Vic) and Hume (Vic/NSW).

GP actions in the management of depression or anxiety also varied across local areas. Depending on where a GP practises, a psychotropic was prescribed on 38% to 74% of GP management occasions, GP counselling on 25% to 51% and a referral to another health professional was provided on 11% to 21% of occasions across local areas.

(Figures 8 to 11)

GP care for patients with arthritis and chronic back pain

Among all people who visit the GP at least once in a year, the percentage of people who had arthritis, chronic back pain or both of these conditions ranged slightly from 16% to 18% in metropolitan, 20% to 21% in regional and 16% to 20% in rural areas.
The percentage of all GP consultations that were with patients who had arthritis, chronic back pain or both of these conditions, irrespective of whether these conditions were managed, ranged from 21% to 27% in metropolitan, 27% to 28% in regional and 19% to 29% in rural areas.
GPs managed arthritis or chronic back pain in about one-fifth of all the consultations with these patients. Across local areas, the proportion of all GP consultations in which arthritis or chronic back pain were actively managed ranged from one in 33 (3%) consultations in Sydney North Shore & Beaches to one in 14 (7%) consultations in Murrumbidgee (NSW) and Tasmania.
GP actions in the management of arthritis or chronic back pain also varied across local areas. Depending on where a GP practises, the percentage of GP management occasions where a medication was prescribed ranged from 52% to 75%, a referral to another health professional was provided from 11% to 22% and imaging was ordered from 8% to 20% across local areas.

(Figures 12 to 15)

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