Abstract
ObjectivesTo estimate the prevalence of common chronic conditions and multimorbidity among patients at GP encounters and among people in the Australian population. To assess the extent to which use of each individual patient’s GP attendance over the previous year, instead of the average for their age-sex group, affects the precision of national population prevalence estimates of diagnosed chronic conditions.Design, setting and participantsA sub-study (between November 2012 and March 2016) of the Bettering the Evaluation and Care of Health program, a continuous national study of GP activity. Each of 1,449 GPs provided data for about 30 consecutive patients (total 43,501) indicating for each, number of GP attendances in previous year and all diagnosed chronic conditions, using their knowledge of the patient, patient self-report, and patient's health record.ResultsHypertension (26.5%) was the most prevalent diagnosed chronic condition among patients surveyed, followed by osteoarthritis (22.7%), hyperlipidaemia (16.6%), depression (16.3%), anxiety (11.9%), gastroesophageal reflux disease (GORD) (11.3%), chronic back pain (9.7%) and Type 2 diabetes (9.6%).After adjustment, we estimated population prevalence of hypertension as 12.4%, 9.5% osteoarthritis, 8.2% hyperlipidaemia, 8.0% depression, 5.8% anxiety and 5.2% asthma. Estimates were significantly lower than those derived using the previous method.About half (51.6%) the patients at GP encounters had two or more diagnosed chronic conditions and over one third (37.4%) had three or more. Population estimates were: 25.7% had two or more diagnosed chronic conditions and 15.8% had three or more.ConclusionsOf the three approaches we have tested to date, this study provides the most accurate method for estimation of population prevalence of chronic conditions using the GP as an expert interviewer, by adjusting for each patient’s reported attendance.
Highlights
Australia has a universal medical insurance scheme called Medicare which covers the individuals cost of visits to general practitioners (GPs)
Of the three approaches we have tested to date, this study provides the most accurate method for estimation of population prevalence of chronic conditions using the GP as an expert interviewer, by adjusting for each patient’s reported attendance
In any single year around 85% of Australians see a GP at least once[1] with GPs providing the bulk of primary care and acting as gate-keepers to government-subsidised health care from other health professionals
Summary
Australia has a universal medical insurance scheme called Medicare which (fully or partially) covers the individuals cost of visits to general practitioners (GPs). The Australian federal government recently announced a “Health Care Home” (Patient Centred Medical Home) initiative whereby patients with chronic and complex conditions voluntarily enrol at a general practice[11]. This plan will include a “bundled payment” (partial capitation) to the practice for each patient enrolled. Preliminary results have shown that multimorbidity is a strong predictor of primary care resource use[13] To cost this initiative, the prevalence of chronic conditions and multimorbidity needs to be measured accurately
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