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Healthy Communities: GP care for patients with chronic conditions in 2009–2013 - Technical Supplement - Measures reported

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

Measures reported

The report’s findings can be considered in the context of four broad themes:

  1. How frequently selected chronic conditions are found among people who visit a GP in a year
  2. How often GPs see patients with one chronic condition or two or more chronic conditions (multimorbidity)
  3. How often GPs actively manage patients for that chronic condition. In other words, how often a GP took steps to mitigate or monitor that condition, as opposed to another unrelated ailment
  4. What actions GPs took to manage that condition (such as prescribing a medication or providing a referral or counselling).

About the patients

The BEACH data was used to identify patients, of any age, with cardiovascular risk conditions based on clinical guidelines6 to support the management of:

  • Hyperlipidaemia
  • Ischaemic heart disease – including acute myocardial infarction (AMI)
  • Type 2 diabetes among people 60 years of age and older
  • Cerebrovascular disease and stroke
  • Congestive heart failure.

Patients identified as having depression, anxiety or both of these conditions include those patients, of any age, who have diagnosed depression, anxiety or both, which is considered by the GP to be a chronic condition.

Patients identified as having arthritis, chronic back pain or both of these conditions include those patients, of any age, who have diagnosed osteoarthritis (OA), rheumatoid arthritis (RA) and/ or chronic back pain. OA and RA account for 86% of all patients with arthritis, in BEACH data, managed by GPs during consultations.

Patients with chronic conditions

Definition

In this report, the prevalence of chronic conditions among patients was defined in terms of people who visit the GP at least once in a year who have a chronic health condition, irrespective of whether the reason for the visit related to the condition or whether the condition was managed at the consultation.

Data are reported for this measure for four groups of chronic conditions:

  • One, two, or three or more common chronic health conditions
  • Selected cardiovascular risk conditions
  • Depression and anxiety
  • Arthritis and chronic back pain.

Data source

These measures are based on data from the BEACH SAND chronic disease substudies conducted between July 2005 and June 2013.

Unit of measurement

Patients with chronic conditions are reported as the number of people who visit the GP at least once in a year.

The BEACH SAND data are based on patients surveyed during GP consultations. However, the likelihood of being sampled depends on the frequency with which patients visit the GP, and this differs by age, gender and region. Therefore, the BEACH SAND data were weighted to match the age and sex distribution of people who visit the GP at least once in a year. See weighting of the data for details.

Geography

The weighted percentages of people who visit the GP at least once in a year who have a chronic health condition are reported by Medicare Local peer group.

Years of data

Combining data from the BEACH SAND chronic disease substudies undertaken between July 2005 and June 2013 created a large enough dataset to allow precision of estimates to be reported at Medicare Local peer group level Box 1.

GP consultations with patients who have a chronic condition

Definition

In this report, GP consultations with patients who have a chronic condition are consultations in which patients are identified by the GP as having one or more chronic conditions irrespective of whether the GP actively managed the chronic condition at that consultation.

Data for this measure are reported for the following four groups of chronic conditions:

  • One, two, or three or more common chronic conditions
  • Selected cardiovascular risk conditions
  • Depression or anxiety or both of these conditions
  • Arthritis or chronic back pain or both of these conditions.

Data source

These measures are based on data from the BEACH SAND chronic disease substudies conducted between July 2005 and June 2013.

Unit of measurement

GP consultations with patients with chronic conditions are reported as the number of GP consultations with patients who have a chronic health condition per 100 GP consultations. Data are reported unweighted for these measures.

Geography

The percentage of GP consultations with patients who have chronic conditions are reported by Medicare Local peer group.

Years of data

Combining data from the BEACH SAND chronic disease substudies undertaken between July 2005 and June 2013 created a large enough dataset to allow precision of estimates to be reported by Medicare Local peer group level Box 1.

GP management of chronic conditions

Definition

In this report, GP management of patient’s chronic conditions are consultations in which a GP actively manages the chronic condition.

Data are reported for these measures for the following four groups of chronic conditions:

  • One, two, or three or more common chronic conditions
  • Selected cardiovascular risk conditions
  • Depression or anxiety
  • Arthritis or chronic back pain

Data source

This measure is based on BEACH encounter data collected from April 2009 to March 2013.

Unit of measurement

GP management of chronic conditions is reported as the percentage of GP consultations in which a chronic condition is actively managed. Data are reported unweighted for these measures.

Geography

The percentage of GP consultations in which a chronic condition is managed are reported by Medicare Local catchment and Medicare Local peer group.

Years of data

Combining four years of data from the BEACH program for the period from April 2009 to March 2013 created a large enough dataset to allow precision of estimates to be reported for the majority of Medicare Local catchments for most indicators. Results for each peer group are also reported to provide indicative results for the Medicare Local catchments where results are suppressed.

Actions taken by GPs to manage chronic conditions

Definition

In this report, actions that GPs undertake to manage selected chronic conditions include:

  • Prescribing of statins in the management of selected cardiovascular risk conditions
  • Providing a referral to another health professional in the management of selected cardiovascular risk conditions
  • Prescribing of psychotropics in the management of depression or anxiety
  • Providing GP counselling in the management of depression or anxiety
  • Providing a referral to another health professional in the management of depression or anxiety
  • Prescribing of a medication in the management of arthritis or chronic back pain
  • Providing a referral to another health professional in the management of arthritis or chronic back pain
  • Ordering imaging in the management of arthritis or chronic back pain.

Data source

These measures are based on data from the BEACH program for the period from April 2009 to March 2013.

Unit of measurement

Actions taken by GPs to manage chronic conditions are reported as the percentage of occasions managing the selected chronic condition at which a specific action is taken. Data are reported unweighted for these measures.

Geography

These measures are reported by Medicare Local catchment and Medicare Local peer group.

Years of data

Combining four years of data from the BEACH program for the period from April 2009 to March 2013 created a large enough dataset to allow precision of estimates to be reported for the majority of Medicare Local catchments for most measures. Results for each peer group are also reported to provide indicative results for the Medicare Local catchments where results are suppressed.

Suppression of estimates

The Authority applies suppression protocols that are customised to the data source used in the report, to ensure confidentiality, representativeness and robustness of estimates when reporting at local levels of geography.

The BEACH survey uses a cluster sample, with GPs being the primary sampling unit and patient encounters being the unit of interest for reporting purposes. Some indicators only relate to a subset of the overall sample, for example patients with a specific chronic condition, and this can lead to small sample sizes for these measures.

To report BEACH data at the local level, the Authority decided and FMRC applied methods and suppression rules to ensure the reliability, representativeness and confidentiality of the data. Suppression rules applied to the data include:

  • Relative standard error of 33% or greater
  • Confidence interval (95%) width of 33 percentage points or greater
  • Relative standard error between 27% and 33%, with significantly wider confidence interval width than the average for that indicator
  • Confidence interval width between 27 and 33 percenatge points, with significantly wider relative standard error than the average for that indicator
  • Patient encounter sample size: minimum of 250 patient encounters in the Medicare Local catchment, with interpret with caution notation for Medicare Local catchments with 250–399 patient encounters
  • Fewer than 10 patient encounters in the numerator
  • Fewer than 20 participating GPs in the Medicare Local catchment.

Weighting of the data

Information on GP consultations with patients who have a chronic condition are collected via the BEACH SAND substudies. In order to estimate the percentage of people who visit a GP in a year who have a chronic condition such as depression, anxiety or arthritis, the survey data were weighted to match the age and sex distribution of people who visit the GP at least once in a year. Medicare Benefits Schedule (MBS) data for the 12 months ending June 2013 were used to perform this weighting, based on the year of claim processing.

BEACH SAND substudy data were weighted by grouping data into 10-year patient age-sex groups (i.e. males aged 0–9 years, males aged 10–19 years etc.). The proportion accounted for by each of these age-sex groups in both the BEACH SAND substudy and MBS data for each Medicare Local catchment’s data were calculated.

For each age-sex group, the proportion that it accounted for in the MBS data was divided by the proportion it accounted for in the BEACH SAND substudy data for each Medicare Local catchment. These weights were then applied to the BEACH SAND substudy data for each Medicare Local catchment, with the results reflecting the attending population.

The age range and gender for each patient was determined from the last Medicare service of any type (not just GP attendances) for the patient, processed by the Department of Human Services.

6 National Health and Medical Research Council (2012). Guidelines for the management of absolute cardiovascular disease risk. [Internet]. [cited 2014 Oct 24]. Available from: https://www.nhmrc.gov.au/guidelines/publications/ext10