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02 Dec 2013

There has been a surge in visits to GPs by patients with chronic illnesses, underlining AMA calls for an overhaul of Medicare rules for the treatment of people with complex and multiple conditions.

Figures compiled by the University of Sydney’s Bettering the Evaluation and Care of Health (BEACH) program show that last year more than a third of all GP consultations involved treatment of chronic illnesses.

Illustrating the extent to which GPs are increasingly being asked to treat multiple complaints at a single visit, the BEACH study, A decade of Australian general practice 2002-03 to 2012-13, found that general practitioners managed, on average, 155 problems for every 100 appointments.

The dimensions of the issue have been highlighted by a separate BEACH report, General practice activity in Australia 2012-13, which includes an examination of the demands patients with type 2 diabetes are making on GP time.

Lead author Associate Professor Helena Britt said 8 per cent of all GP visits involved patients with type 2 diabetes, and such consultations took about double the average time.

The study found that patients with type 2 diabetes were much more likely than the general population to see a doctor, and they invariably suffered multiple chronic conditions that were complex to manage and frequently required lengthy consultations.

Associate Professor Britt said people, on average, saw a GP 5.6 times a year, but among those with type 2 diabetes, the average was eight visits a year.

She said that, of the 1.2 million diagnosed with type 2 diabetes, 97 per cent had at least one other chronic condition, and 40 per cent had five or more. She said high blood pressure, high cholesterol, hypertension, osteoarthritis, ischaemic heart disease and depression were “the most common”.

Associate Professor Britt said the ageing of the population was also adding to the chronic disease burden, and increasing the demands on GPs.

“As the population ages, chronic diseases are accounting for an increasing proportion of GP workload,” she said. “Compared with 10 years ago, there are now more visits for depression, diabetes, atrial fibrillation and hypothyroidism.”

All up, the BEACH program found that, on average, 55.7 chronic problems were managed for every 100 GP visits.

AMA President Dr Steve Hambleton said the report showed that not only were general practitioners dealing with more problems at each visit, they were also critical in connecting patients with other forms of care.

The BEACH study found that, in 2012-13, GPs made 7.6 million more referrals to other health practitioners than they had a decade earlier, including an extra 3.7 million to medical specialists and an extra 3.5 million to allied health services, such as physiotherapists, psychologists and dieticians.

Dr Hambleton said the finding showed that GPs were effectively coordinating care across a range of disciplines.

“These reports underline the unique leadership role of GPs in the health system,” he said. “GPs are ensuring that people are receiving the right care at the right time from the right health professional.”

Dr Hambleton said the reports showed the extent of demands made on GPs – almost 127 million GP services were claimed through Medicare in 2012-13, an average of around 2.5 million a week.

But he said attempts to reduce GP workload by hiving off more functions to other health professionals, such as pharmacists, were misguided.

Last month, the nation’s Health Ministers approved a plan to give autonomous prescribing rights to a range of non-medical practitioners in order to ease access to GPs.

But Dr Hambleton questioned the assumptions underlying the policy and warned the change risked fragmenting care and exposing patients to harmful consequences.

“Any moves to allow other health professionals to do the work of a GP must be resisted,” he said. “Instead, GPs must receive stronger support to maintain and build on their key role as community demand inevitably increases in coming years.”

Dr Hambleton said one of the most important ways to achieve this was to reform Medicare rules regarding the treatment of patients with chronic illnesses.

“GPs are integral to keeping patients with chronic disease healthy and out of hospital, but current Medicare-funded chronic disease management arrangements are too limited, are difficult for patients to access, and involve considerable red tape and bureaucracy.”

His concerns have been borne out by a study published in The Australian Health Review that found the proportion of GPs providing consultations of 40 minutes or longer fell from 72 per cent in 2006 to 62 per cent in 2009. Over the same period, the number of such consultations provided per GP fell 26 per cent.

Lead author Michael Taylor and his colleagues speculated that the red tape burden and anxiety about satisfying Medicare requirements contributed to the decline, and warned that there is little evidence yet that reforms introduced in 2010, including larger fees for longer consultations, were having an effect.

Dr Hambleton said the Government should adopt the AMA’s comprehensive plan for boosting chronic care, Improving Care for Patients with Chronic and Complex Care Needs (http://ama.com.au/node/5519).

 “The AMA plan enhances existing arrangements and supports patients to spend more time with their GP when they need to,” he said. “It provides patients with streamlined access to a broad range of allied health and other support services, and it supports a more proactive approach to the delivery of care.

“GPs must be given greater support and scope to provide access to multidisciplinary care and support services for patients with chronic and complex disease.”

Adrian Rollins

 


Published: 02 Dec 2013