National Health Performance Authority Report Indicates GPs Manage Patients Differently Across Geographical Areas

An inaugural report by the  National Health Performance Authority  provides insights into how GPs manage patients with chronic conditions across different geographical areas.
The report, which captures data from 2005 to 2013, shows that around half of the people (44% to 56%) who visited a GP once in a year had one or more chronic conditions such as back pain, high cholesterol, arthritis, type 2 diabetes, asthma and anxiety. People with chronic conditions are high users of the health care system, comprising around 85% of the total burden of disease in Australasia.
Depending on the community, GPs spend from 51% to 66% of their consultations providing care to people with one or more common chronic conditions, although not necessarily treating them for those conditions. However, GPs actively manage these conditions in just 34% to 50% of consultations through activities such as counselling, prescription of medicine or referral to a specialist.
The National Health Performance Authority report provides insights into the geographic variation across local areas in the actions GPs take to manage some chronic conditions. The report shows from 2009 to 2013:

• The percentage of patients in big cities who were actively managed for anxiety or depression and received a prescription for psychotropic drugs (such as antidepressants) ranged from 38% in Northern Sydney to 59% in Sydney North Shore & Beaches. Across regional and rural communities, this ranged from 57% in Barwon (Vic) to 74% in Hume (Vic/NSW). GP referral to other health professionals ranged from 11% in Southern Adelaide-Fleurieu-Kangaroo Island and Central Adelaide & Hills to 21% in Eastern Sydney.


• The percentage of patients who were actively managed for selected cardiovascula rrisk conditions and prescribed statins ranged from 26% in South Eastern Melbourne and Sunshine Coast (Qld) to 40% in Eastern Sydney and Central Qld. GP referral to other health professionals ranged from 4% in Northern Melbourne, Bayside (Vic) and Central Qld to 11% in Nepean-Blue Mountains (NSW).


• The percentage of patients who were actively managed for arthritis or chronic back pain and prescribed medications ranged from 52% in Northern Sydney to 75% in Nepean-Blue Mountains (NSW). Ordering of imaging by GPs ranged from 8% in North Coast NSW, Macedon Ranges and North Western Melbourne and Northern Adelaide to 20% in Central Coast (NSW).

National Health Performance Authority (NHPA) CEO Dr Diane Watson said the variation revealed in today’s report showcases the diverse approaches GPs used to manage chronic conditions in local areas across Australia.
“Today’s report offers new information that can provide a starting point for health care professionals to better learn about optimal approaches to care for their community’s needs,” Dr Watson said.
Chief Executive Officer of the Consumers Health Forum believes there should be closer scrutiny of medical practices in Australia to ensure differences in the way doctors treat patients with chronic conditions are not extreme.
“It is not the role of the NHPA to say which doctors are or are not practising according to acceptable parameters.  But some of the differences are great enough to prompt consumers to ask reasonably:  are some doctors getting it right and some getting it or wrong?
“The failure to prescribe statins for patients with high cholesterol levels, or to prescribe the wrong or no dose of psychotropic drugs to people suffering depression or anxiety where clinically appropriate, can have serious consequences for patients, perhaps delaying improvement, or worse, dooming patients to unnecessary suffering and even death.
“CHF strongly supports the NHPA’s work.  In so many areas it has for the first time revealed to Australians the performance of health services by local area.
“If the Federal and State governments want to ensure we are getting best value for the $100 billion in public money spent on health services, they should be using the NHPA findings to calculate what is best for our physical and fiscal health.
“The results of this survey of four years of records throughout Australia, come as general practice faces one of its most testing upheavals in years, with the introduction of the Government’s $5 cut to non-concession GP Medicare rebates.
“The Government has made much play of the rising cost of Medicare, now at about $20 billion a year.  But there is little or no rigorous examination of the quality of the treatment being paid for.
“CHF has urged the Government for the past year to look at ways we can make the health system more cost effective rather than imposing a cost barrier on the most important entry point to our health system: the GP,” Mr Stankevicius said.
The Healthy Communities: GP care for patients with chronic conditions in 2009–2013 report uses data sourced from the Bettering the Evaluation and Care of Health (BEACH) program, which is conducted by the Family Medicine and Research Centre based at the University of Sydney. To ensure comparisons are as fair as possible, local areas across Australia are allocated to peer groups in the report, based on similar geographic remoteness and socioeconomic status.
The new report is available on www.myhealthycommunities.gov.au which has a new tool – MyReport – that allows users to build their own free customised report for more than 100 measures of health and care. These measures include those in today’s report and others previously reported on such as obesity rates, childhood immunisation, life expectancy, avoidable hospitalisations and more.
From next week (Monday 15 December) MyReport will have enhanced capacity to build reports by Primary Health Network (PHN) boundaries which will replace Medicare Locals.