Bettering The Evaluation And Care Of Health Research Articles

Prevalence and patterns of comorbidities in older people with type 2 diabetes in Australian primary care settings.

The aim of this study was to identify the prevalence and patterns of comorbidity in community-dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia. This study involveda cross-sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub-study data. In a series of sub-studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper-based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns. Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6-70.0), followed by arthritis 52% (95% CI: 48.8-54.8), hyperlipidaemia 45% (95% CI: 41.8-47.9), ischemic heart disease, 23% (95% CI: 20.7-24.9), depression 16% (95% CI: 48.8-54.8), atrial fibrillation 10% (95% CI: 8.9-11.6), congestive heart failure 7% (95% CI: 6.0-8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4-8.2) and peripheral vascular disease 5% (95% CI: 4.4-6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure. The prevalence of cardiovascular and non-cardiovascular comorbidities in community-dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long-term care for this population.

On- and off-label utilisation of antipsychotics in Australia (2000-2021): Retrospective analysis of two medication datasets.

To determine antipsychotic utilisation patterns in Australian adults from 2005 to 2021, with a focus on on-label and off-label prescriptions. We examined antipsychotic dispensing trends in adults from 2005 to 2021 using a 10% sample of the Pharmaceutical Benefits Scheme (PBS) dataset, which contains patient-level information on medicines dispensed throughout Australia. The lack of diagnostic information in PBS was substituted by analysing BEACH (Bettering the Evaluation And Care of Health) dataset, a cross-sectional national survey from 2000 to 2016, consisting of data from general practitioner-patient encounters. There were 5.6 million dispensings for 164,993 patients in PBS throughout this period; 69% patients had >1 dispensing, with a median of 6 per patient. Calculating the estimated period of exposure gave a total of 693,562 treatment episodes, with a median duration of 80 days. There were steady increases in both the incidence and prevalence of antipsychotic dispensings, mainly due to oral second-generation antipsychotics. The most commonly prescribed antipsychotics were quetiapine, olanzapine and risperidone, with a significant portion of patients receiving low-dose quetiapine without dose titration. Analysis of diagnostic indications from BEACH indicated that 27% of antipsychotic prescriptions were off-label for indications such as depression, dementia, anxiety and insomnia, at much lower prescribed daily dosages. The increasing prescribing and off-label use highlights concerns about chronic adverse effects caused by antipsychotics. The combined analysis of medication dispensings and the diagnostic indications for which they are prescribed is a novel approach and throws a spotlight on the need for additional monitoring of antipsychotics.

Under or over? General practitioner charging of Medicare

In 2022, media reports alleged that doctors, particularly general practitioners (GPs), are defrauding Medicare, claiming $8 billion lost through fraud/non-compliance. This study examined Medicare Benefits Schedule billing patterns by consultation length to estimate overcharging or undercharging by GPs, and the cost/savings to Medicare. A subset of data from the Bettering the Evaluation And Care of Health (BEACH) program from 2013 to 2016, which included length of consultation information, was analysed. Of 89,765 consultations, GPs undercharged 11.8% of consultations andovercharged 1.6%. Of the 2760 GPssampled, 816 (29.6%) overcharged atleast once and 2334 (84.6%) undercharged at least once. Of the GPs who overcharged at least once, 85.4% also undercharged. The total effect of GP undercharging and overcharging was a net saving of $351.7 million to Medicare. This study shows that GPs undercharging and overcharging saved Medicare over one-third of a billion dollars in 2021-22. The findings of this study do not support the media claims of widespread fraud by GPs.

Comorbidity patterns in older patients with diabetes in primary care: a cross-sectional study

Abstract Funding Acknowledgements Type of funding sources: None. Background Diabetes is a well-known risk factor for cardiovascular diseases and continues to be a global public health challenge. In Australia, prevalence rates of diabetes increase with age with almost 1 in 5 older people reported being diagnosed with diabetes. Older persons with diabetes are also more likely to have multiple comorbidities adding to their complexity. A better understanding of comorbidity patterns and their associated factors in older people with diabetes is instrumental to identify groups of individuals that differ in healthcare needs, resources utilized, and health trajectories. Purpose To identify comorbidity patterns in community-dwelling older adults with type 2 diabetes attending general practice settings in Australia. Methods This is a cross-sectional study based on the Bettering the Evaluation And Care of Health (BEACH) data. The BEACH program was a continuous, national study of the state of general practice clinical activity in Australia from 1998 to 2016. As part of the program, General Practitioners (GPs) would collect additional patient information during patient visits through structured paper-based recording sheets. For the purposes of this sub-study, a random sample of 1800 participating GPs were invited to record all diagnosed chronic conditions for 30 consecutive patients over twelve five-weeks recording periods between November 2012 and March 2016. The dataset was analyzed with descriptive analysis and exploratory factor analyses were applied to examine comorbidity patterns. Result From the dataset, there were 14 042 patients aged ≥65 with recorded chronic conditions. Of these, 2688 reported to have other comorbidities in addition to the diagnosis of diabetes. Hypertension was present in 67.33% (95% CI: 64.62 – 70.04) of these participants, followed by hyperlipidemia, 44.85% (95% CI: 41.80 –47.90), ischemic heart disease, 22.81% (95% CI: 20.74 – 24.87), atrial fibrillation, 10.25% (95% CI: 8.86 – 11.63), congestive heart failure, 7.03% (95% CI: 5.99 – 8.09), stroke/cerebrovascular accident, 6.76% (95% CI:5.36 -8.16) and peripheral vascular disease 5.26% (4.36 – 6.15). Top non-cardiovascular co-morbidities included arthritis, 51.78% (95% CI: 48.80–54.77) and depression, 15.52% (95% CI 13.78 –17.27). We identified two comorbidity patterns among older people with diabetes. The first were primarily psychological and musculoskeletal (Depression, Anxiety, Insomnia, Chronic Back Pain, Arthritis, Gastroesophageal Reflux Disease, Osteoporosis) and the second were cardiovascular conditions (Congestive Heart Failure, Ischaemic Heart Disease, Atrial Fibrillation, Peripheral Vascular Disease) and Chronic Renal Failure. Conclusion The prevalence of cardiovascular and non-cardiovascular comorbidities in older patients with diabetes was high. These findings highlight the need for elaborating primary care strategies to reduce cardiovascular risk and improve long-term care for this population.

Rates of psychotropic medicine prescribing in paediatric populations in Australian general practice from 2000-2016

General practitioner (GP) prescribing of psychotropic medicines to paediatric patients is increasing across countries, sparking the need for additional research into this field. We examined prescribing rates, GP and patient characteristics and indications associated with prescribing psychotropic medicines to paediatric patients in Australian general practice, using data from the Bettering the Evaluation and Care of Health (BEACH) program. We extracted all encounters with children aged 3 to 17 from 2000 to 2016. Psychotropic medicines were defined as those in the ATC codes N05 (Psycholeptics) and N06 (Psychoanaleptics). Of the 144,397 encounters, GPs prescribed 1829 psychotropic medicines to paediatric patients at an average rate of 1.16 prescriptions per 100 encounters (95% confidence interval 1.09-1.23). We found that the rate of psychotropic medicines prescribed to paediatric patients in Australian general practice increased. Patients who were adolescent, female, socio-economically disadvantaged or from an English-speaking background were significantly more likely to be prescribed a psychotropic medicine. GP practices in remote or regional areas and Australian graduate GPs were more likely to prescribe psychotropic medicines to paediatric patients. Depression, attention deficit hyperactivity disorder, anxiety and autism were the most common psychiatric indications managed with psychotropic medicines. Antidepressants, psychostimulants, benzodiazepines, antipsychotics and other psychotropic medicines were prescribed, signifying a high rate of off-label use. Sertraline was the most common psychotropic medicine prescribed, followed by fluoxetine and methylphenidate. Future studies involving data from other prescribers, e.g. paediatricians and psychiatrists, and studies linking prescribed medicines to their indications may widen our understanding of psychotropic medicine prescribing in Australian paediatric patients.

Changes in hyperglycaemia-related testing for prediabetes and type 2 diabetes mellitus management: a prospective, cross-sectional survey of 16 years of general practice data from Australia

BackgroundThe rising prevalence of prediabetes increases the population risk of type 2 diabetes mellitus (T2DM), metabolic syndrome and cardiovascular disease. Early identification by General Practitioners (GPs) provides opportunities for lifestyle modifications that can lower these risks.MethodsThis study examined 16 years of hyperglycaemia-related testing for patients in Australia aged 13 years or older with, or at risk of a diagnosis of T2DM. The Bettering the Evaluation and Care of Health (BEACH) study is a national cross-sectional survey, with a single-stage, cluster sampling design. Approximately 1,000 GPs were randomly selected annually (2000/01–20,015/16) from across Australia, who each recorded details of 100 consecutive clinical encounters with consenting patients. Point estimates were adjusted for intracluster correlation and GP characteristics.ResultsFifteen thousand six hundred seventy nine GPs recorded details of 1,387,190 clinical encounters with patients aged 13 + years. Prediabetes and T2DM were managed at 0.25% (95% CI: 0.24–0.27%) and 3.68% (95% CI: 3.62–3.73%) of encounters respectively. By the end of the study, the proportion of encounters where prediabetes was managed was 2.3 times higher and for T2DM, 1.5 times higher. The proportion of prediabetes (55.9%, 95% CI: 53.9–57.8%) and T2DM (27.3%, 95% CI: 26.7–27.9%) management occasions where one or more hyperglycaemia-related tests were requested were relatively stable. However, differences in the types of tests were observed. For prediabetes, glucose tolerance tests were most common but from 2014/15, requests for HbA1c tests began to increase. For T2DM, HbA1c tests were most common, and requests for one or more glucose tests gradually declined.ConclusionThe observed 16-year annual trends align with the rising incidence of prediabetes and T2DM. GPs appeared to be strongly influenced by changes to the national insurance scheme and clinical guidelines for hyperglycaemia-related pathology testing. However, some GPs may have been pre-empting policy changes as there was also evidence of ‘unendorsed’ testing, notably for prediabetes, that warrants further investigation. The increasing proportion of encounters for prediabetes, coupled with a high proportion of management occasions where pathology was requested have substantial resource implications. Calls to lower the risk threshold for prediabetes screening therefore warrant an economic analysis. Ongoing, reliable, up-to-date data is needed to inform clinical practice guidelines and policy in Australia.

Australian children’s foot, ankle and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data

ObjectivesTo explore children’s foot, ankle and leg consultation patterns and management practices in Australian primary care.DesignCross-sectional, retrospective study.SettingAustralia Bettering the Evaluation and Care of Health program dataset.ParticipantsData were extracted for...

Trends in management of hip and knee osteoarthritis in general practice in Australia over an 11-year window: a nationwide cross-sectional survey

BackgroundWe aimed to describe trends in knee and hip OA management by general medical practitioners (GPs) in Australia. MethodsWe analysed cross-sectional survey data from the Bettering the Evaluation and Care of Health (BEACH) program (1,000 randomly-selected GPs annually recording 100 consecutive patient encounters) over two periods: Period one April 1, 2005-March 31, 2010 and period two April 1, 2010-March 31, 2016. This included data from 10,738 GPs and 1,073,800 patient encounters with 6,565 GPs and 9,196 patient encounters for hip/knee OA. Data were summarized using descriptive statistics and 95% confidence intervals around point estimates. FindingsRate of knee OA problems managed by GPs increased in period two (7•1 (6•9-7•4) vs 6•2 (95% CI 6•0-6•5) per 1,000 all encounters), with a similar trend for hip OA. Encounter rates rose for some subgroups but remained stable for vulnerable subgroups. Although use of Medicare chronic disease management items, referral to allied health professionals and advice/education and lifestyle management (knee OA) increased, rates remained low. Use of MRI imaging rose. Overall medication rates were stable but substantially higher than non-pharmacological treatments. Declining reliance on non-steroidal anti-inflammatory drugs and glucosamine and increased reliance on paracetamol (knee OA) and opioids were demonstrated. InterpretationGPs in Australia are more frequently managing knee and hip OA. While small changes in GP management actions occured, rates of recommended first-line non-pharmacological treatments remained low and imaging, medications, and surgical referral rates high. Strategies are needed to optimise lifestyle management and reduce low-value care, with attention to healthcare disparities. FundingFunding was provided for this report by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Translational Research in Musculoskeletal Pain (#1079078).

Characteristic-specific rates of rheumatoid arthritis and its management in Australian general practice.

A 2006-16 study investigated rheumatoid arthritis (RA) management by Australian general practitioners (GPs). The aim of this study was to examine: GP-patient encounters for RA management over the decade, treatments provided for RA management (new and continuing), characteristics of patients managed and ofGPs providing management, and differences across regional areas and areas of socioeconomic advantage/disadvantage, compared with Australian guidelines. GP self-reported data collected through the Bettering theEvaluation And Care of Health (BEACH) program were analysed for patient and GP characteristics and management actions (medications, referrals, investigations, procedures) nationally, regionally and bysocioeconomic advantage/disadvantage levels. Proportions of RA management encounters: remained static across the decade, were higher for female patients, increased with patient and GP age, increased with socioeconomic disadvantage in major cities, were higher for patients from English-speaking backgrounds, and were higher in regional/remote areas. GP behaviour indicates equity and uniformity in RA management nationally. The results suggest adherence to current guidelines for total and new RA contacts.

Management of plantar heel pain in general practice in Australia.

Studies have described general practitioner (GP) management of plantar heel pain from some countries; however, there is limited information from Australian general practice. To describe patient and GP characteristics, and management actions for plantar heel pain in Australian general practice. Secondary analysis of data from the Bettering the Evaluation and Care of Health (BEACH) dataset. Data were summarised using descriptive analysis and robust 95% confidence intervals (CIs) were calculated around point estimates. Multivariate logistic regression identified predictors of plantar heel pain management. From 1,568,100 encounters between April 2000 and March 2016, plantar heel pain was managed at 3007 encounters. GPs manage plantar heel pain approximately once every 500 encounters, which extrapolates to 271,100 encounters in 2015-2016. Patient factors independently associated with plantar heel pain encounters included female sex (OR 1.27, 95% CI 1.17-1.34 cf. males), being aged 45-64 (OR 3.44, 95% CI 2.94-4.01 cf. aged 75+) and patients from a non-English speaking background (OR 1.22, 95% CI 1.07-1.39). Plantar heel pain was frequently managed using medication (45.1 per 100), with non-steroidal anti-inflammatory drugs the most common (22.8 per 100). GPs also commonly provided counselling/advice/education (32.4 per 100), and referrals for diagnostic imaging (19.1 per 100) and to podiatrists (12.0 per 100). Plantar heel pain is a frequently managed foot condition in Australian general practice. GPs use medication, counselling and education, diagnostic imaging and referral to podiatrists for management. Further research is required to understand the drivers of these management actions and whether they are effective.

PIN30 A Retrospective Modelling Study Assessing the Clinical and Economic IMPACT of the PCV Infant Program in Australia

Pneumococcal diseases caused by Streptococcus pneumoniae pose a significant health and economic burden. Australia introduced the 7-valent pneumococcal conjugate vaccine (7vPCV) on the universal infant National Immunisation Program (NIP) in 2005 and replaced it with the 13-valent (13vPCV) in 2011. The objective was to quantify the clinical and economic impact of the universal infant PCV program in Australia. A decision-analytic model was adapted to estimate the historical impact of PCVs in Australia. Historical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) for age strata were obtained from Australian epidemiologic databases, supplemented with published data. Hospitalization and procedure data were from Australian Institute of Health and Welfare. General Practitioner encounters for pneumonia and AOM were from Bettering the Evaluation and Care of Health (BEACH) dataset. Costs were from Medicare Benefits Schedule in 2018 Australian dollars. Historical observed changes in disease for the universal PCV NIP era (2005- 2017) were compared against a “no-vaccine” scenario. The expected incidence for no-vaccine scenario in years 2005-2017 was calculated using pre-universal PCV NIP era (2001-2004) data. Averted cases, deaths, incremental costs and quality-adjusted life years (QALYs) were obtained by subtracting the vaccine scenario totals from the no-vaccine scenario totals. From the inclusion in the universal infant NIP, 7vPCV and 13vPCV are estimated to have prevented 1,770,024 cases of pneumococcal disease (IPD=16,392; AOM=1,575,491; pneumonia=102,059) and 1,195 associated deaths. Over this period, there was a total 24,335 QALYs gained. Costs for the universal infant NIP were offset by $733 million direct costs saved, resulting in an incremental cost-effectiveness ratio of $3,347 per QALY gained. This analysis showed the substantial public health and economic value that 7vPCV and 13vPCV have provided from sustained use in Australia. Maintaining 13vPCV on the Australian infant NIP will likely provide continued return-on-investment and sustained reductions in pneumococcal disease.

Adequacy of Australia's GP workforce: estimating supply and demand, 2005-06 to 2015-16.

Objective A 2011 Australian study calculated average annual general practitioner (GP) utilisation and predicted numbers required to meet demand to 2020. The objective of the present study is to calculate average annual GP utilisation in 2015-16 compared with clinical demand predicted in 2005-06. Methods Demand was calculated from Medicare Benefits Schedule, Department of Veterans' Affairs and Australian Bureau of Statistics data. Length of consultation and average clinical hours worked per week (from 2002-03 to 2015-16) was drawn from GP self-reported data collected through the Bettering the Evaluation And Care of Health (BEACH) program. GP workforce numbers were sourced from the Australian Institute of Health and Welfare 'Medical practitioners workforce 2015' report. Results Predicted demand from 2005-06 to 2009-10 approximated GP supply. Beyond 2011, approximately 2674 additional GPs were required in 2015-16 to maintain the average annual 2005-06 GP workload. An additional 5941 GPs were required to meet the increase in clinical demand (for GP services to patients) from 2005-06 to 2015-16. Conclusions The number of GP clinical hours worked decreased, and clinical demand increased. Ongoing efforts are required to ensure the supply of GPs to meet the clinical demand of Australia's aging population. What is known about this topic? For the past three decades there has been concern about the supply of GPs in Australia. In recent years the Australian Government has taken several steps to improve access to GP services by increasing the overall supply of GPs and encouraging a more even distribution of GPs across Australia. A 2011 Australian study calculated average annual GP service utilisation and predicted the number of GPs required to meet clinical demand to 2020. There are current concerns that the GP workforce has reached a state of oversupply. What does this paper add? This study concludes that the GP workforce is not in a state of oversupply, confirming that patient clinical demand increased through both population growth and the aging of the population. Although the number of GPs increased, the number of clinical hours worked by (male) GPs decreased. Therefore, the rise in the number of GPs did not result in a proportional rise in GP workforce capacity. Clearly standardised definitions and inclusions for counting the GP workforce would improve accuracy in measuring this section of the health workforce. What are the implications for practitioners? GP workforce supply will require ongoing monitoring over coming years considering the increasing population, the aging of the population, declining clinical GP working hours and the approaching mass retirement of older GPs.

Predicting patient use of general practice services in Australia: models developed using national cross-sectional survey data

BackgroundThe ageing population and increasing prevalence of multimorbidity place greater resource demands on the health systems internationally. Accurate prediction of general practice (GP) services is important for health workforce planning. The aim of this research was to develop a parsimonious model that predicts patient visit rates to general practice.MethodsBetween 2012 and 2016, 1449 randomly selected Australian GPs recorded GP-patient encounter details for 43,501 patients in sub-studies of the Bettering the Evaluation and Care of Health (BEACH) program. Details included patient characteristics, all diagnosed chronic conditions per patient and the number of GP visits for each patient in previous 12 months. BEACH has a single stage cluster design. Survey procedures in SAS version 9.3 (SAS Inc., Cary, NC, USA) were used to account for the effect of this clustering. Models predicting patient GP visit rates were tested. R-square value was used to measure how well each model predicts GP attendance. An adjusted R-square was calculated for all models with more than one explanatory variable. Statistically insignificant variables were removed through backwards elimination. Due to the large sample size, p < 0.01 rather than p < 0.05 was used as level of significance.ResultsNumber of diagnosed chronic conditions alone accounted for 25.48% of variance (R-square) in number of visits in previous year. The final parsimonious model accounted for 27.58% of variance and estimated that each year: female patients had 0.52 more visits; Commonwealth Concessional Health Care Card holders had 1.06 more visits; for each chronic condition patients made 1.06 more visits; and visit rate initially decreased with age before increasing exponentially.ConclusionsNumber of diagnosed chronic conditions was the best individual predictor of the number of GP visits. Adding patient age, sex and concession card status explained significantly more variance. This model will assist health care planning by providing an accurate prediction of patient use of GP services.

General practitioner referrals to exercise physiologists during routine practice: A prospective study

ObjectivesPhysical activity is essential in the primary and secondary prevention of several chronic diseases and should be a standard component of clinical care. The aims of this study were to examine the trends and characteristics of referrals to exercise physiologists in routine care in a nationally representative sample of general practitioners (GPs) in Australia. DesignThis prospective study was an analysis of Bettering the Evaluation and Care of Health (BEACH) GP data from April 2009 to March 2016. MethodsIn total, each of 6827 randomly sampled GPs recorded details of 100 consecutive encounters (N=682,700). The rate of exercise physiologist referrals was calculated by patient and GP characteristics. ResultsOver the study period, the rate at which GPs referred their patients significantly increased from 0.38 to 1.44 per 1000 encounters. Patients aged 45–64 years were most likely to be referred (1.32 per 1000 encounters). Patients from non-English-speaking backgrounds were referred at less than half the rate (0.41 per 1000) of those from English speaking backgrounds (0.96). Female GPs referred patients (1.27 per 1000 encounters) twice as often as male GPs (0.64). One-third (35.3%) of GP referrals were made for problems relating to the endocrine, nutritional and metabolic systems (e.g., obesity, diabetes mellitus); only 1.6% of referrals were made for mental health conditions. ConclusionsAlthough increasing, the rate of GP referral to exercise physiologists was low and associated with patient and GP characteristics. Education of GPs about the role of exercise physiologists in the prevention and management of chronic disease is needed.

Validation of electronic medical data: Identifying diabetes prevalence in general practice

Electronic medical records are increasingly used for research with limited external validation of their data. This study investigates the validity of electronic medical data (EMD) for estimating diabetes prevalence in general practitioner (GP) patients by comparing EMD with national Bettering the Evaluation and Care of Health (BEACH) data. A "decision tree" was created using inclusion/exclusion of pre-agreed variables to determine the probability of diabetes in absence of diagnostic label, including diagnoses (coded/free-text diabetes, polycystic ovarian syndrome, impaired glucose tolerance, impaired fasting glucose), diabetic annual cycle of care (DACC), glycated haemoglobin (HbA1c) > 6.5%, and prescription (metformin, other diabetes medications). Via SQL query, cases were identified in EMD of five Illawarra and Southern Practice Network practices (30,007 active patients; from 2 years to January 2015). Patient-based Supplementary Analysis of Nominated Data (SAND) sub-studies from BEACH investigating diabetes prevalence (1172 GPs; 35,162 patients; November 2012 to February 2015) were comparison data. SAND results were adjusted for number of GP encounters per year, per patient, and then age-sex standardised to match age-sex distribution of EMD patients. Cluster-adjusted 95% confidence intervals (CIs) were calculated for both datasets. EMD diabetes prevalence (T1 and/or T2) was 6.5% (95% CI: 4.1-8.9). Following age-sex standardisation, SAND prevalence, not significantly different, was 6.7% (95% CI: 6.3-7.1). Extracting only coded diagnosis missed 13.0% of probable cases, subsequently identified through the presence of metformin/other diabetes medications (*without other indicator variables) (6.1%), free-text diabetes label (3.8%), HbA1c result* (1.6%), DACC* (1.3%), and diabetes medications* (0.2%). While complex, proxy variables can improve usefulness of EMD for research. Without their consideration, EMD results should be interpreted with caution. Enforceable, transparent data linkages in EMRs would resolve many problems with identification of diagnoses. Ongoing data quality improvement remains essential.

The likelihood of general practitioners referring patients to physiotherapists is low for some health problems: secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) observational study.

Which health problems do medical general practitioners (GPs) most commonly refer to physiotherapists? What is the likelihood of GPs referring patients for specific health problems? Secondary analysis of data from the Bettering the Evaluation and Care of Health (BEACH) study, which is a national observational study of Australian general practice clinical activity. People at GP encounters between April 2010 and March 2015. The outcomes were the proportion of all (new) health problems that were referred to a physiotherapist, the distribution of health problems referred to physiotherapists, and the likelihood of referral of (all and new) specific health problems to physiotherapists. There were 6904 referrals to a physiotherapist from 775893 GP encounters, which equated to 0.89% (95% CI 0.86 to 0.92). Among the 286858 new health problems, 2987 were referred to a physiotherapist (1.04%, 95% CI 0.99 to 1.09). The health problems that were most commonly referred were back complaints (18.6%), sprains (10.3%) and osteoarthritis (8.6%). However, when these three problems presented as a new health problem, the likelihood of referral was low (14.4, 11.9 and 5.4%, respectively). The new health problems most likely to result in a referral were acquired deformity of the spine (which includes kyphoscoliosis, kyphosis, lordosis and scoliosis) (17.7%, 95% CI 8.2 to 27.2) and neck complaints (17.4%, 95% CI 14.3 to 20.6). Most referrals made to physiotherapists were for musculoskeletal problems. However, even among the most commonly referred problems (such as back complaints and osteoarthritis), the likelihood of referral was low when they presented as a new problem. There is an opportunity to increase referrals from general practice to physiotherapy for many common conditions with effective physiotherapy interventions. [Dennis S, Watts I, Pan Y, Britt H (2018) The likelihood of general practitioners referring patients to physiotherapists is low for some health problems: secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) observational study. Journal of Physiotherapy 64: 177-181].

Primary care access for mental illness in Australia: Patterns of access to general practice from 2006 to 2016.

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.

Primary care for people with an intellectual disability - what is prescribed? An analysis of medication recommendations from the BEACH dataset.

BackgroundPeople with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID.AimTo compare medications recommended by GPs at encounters where ID is recorded versus other encounters.Design & settingAnalysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003–December 2012 inclusive.MethodMedication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the ‘ID group’ (n = 563). These encounters were compared with all other encounters (the ‘non-ID group’, n = 1 004 095) during the study period. Following age–sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs).ResultsAntipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters.ConclusionHigher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.

Management of Whiplash Associated Disorders in Australian general practice

BackgroundWhiplash Associated Disorders (WAD) are common and costly, and are usually managed initially by general practitioners (GPs). How GPs manage WAD is largely unstudied, though there are clinical guidelines. Our aim was to ascertain the rate of management (percentage of encounters) of WAD among patients attending Australian general practice, and to review management of these problems, including imaging, medications and other treatments.MethodsWe analysed data from 2013 to 2016 collected by different random samples of approximately 1000 general practitioners (GPs) per year. Each GP collected data about 100 consecutive consultations for BEACH (Bettering the Evaluation and Care of Health), an Australian national study of general practice encounters.Main outcome measures were: the proportion of encounters involving management of WAD; management including imaging, medications and other treatments given; appropriateness of treatment assessed against published clinical guidelines.ResultsOf 291,100 encounters from 2919 GP participants (a nationally representative sample), WAD were managed at 137 encounters by 124 GPs (0.047%). Management rates were 0.050% (females) and 0.043% (males). For 63 new cases (46%), 19 imaging tests were ordered, most commonly neck/cervical spine x-ray (52.6% of tests for new cases), and neck/cervical spine CT scan (31.6%). One or more medications were prescribed/supplied for 53.3% of WAD. NSAIDs (11.7 per 100 WAD problems) and compound analgesics containing paracetamol and opioids (10.2 per 100 WAD problems) were the commonest medications used by GPs overall. Paracetamol alone was used in 8 per 100 WAD problems. The most frequent clinical/procedural treatments for WAD were physical medicine/rehabilitation (16.1 per 100 WAD problems), counselling (6.6), and general advice/education (5.8).ConclusionsGPs refer about 30% of new cases for imaging (possibly overutilising imaging), and prescribe a range of drugs, approximately 22% of which are outside clinical guidelines. These findings suggest a need for further education of GPs, including indications for imaging after whiplash injury, identification of those more likely to develop chronic WAD, and medication management guidelines. WAD carry a large personal and economic burden, so the impact of improvements in GP management is potentially significant.

Worsening trends in analgesics recommended for spinal pain in primary care.

Limited evidence exists on secular trends of analgesics for spinal pain. We investigated general practitioner's (GP) recommendations of analgesic medicines for spinal pain and investigated characteristics associated with their recommendation. We accessed data on spinal pain consultations from the Bettering the Evaluation and Care of Health (BEACH) database, a nationally representative database on GP activity in Australia. Data extracted included consultation details and management provided. Medicines recommended were grouped as simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics or neuropathic pain medicines. Multivariate logistic regression determined if patient characteristics and GP characteristics were associated with medication recommendations. We analysed BEACH data for 9100 GPs who managed 39,303 patients with spinal pain between 2004 and 2014. Over the decade, analgesic recommendations increased. After accounting for patient and GP characteristics, there was a significant increase in the rate single-ingredient opioid analgesics [annual relative increase of 6% (RR 1.06 (95% CI 1.05-1.07), P<0.001)] and neuropathic pain medicines [annual relative increase of 19% (RR 1.19 (95% CI 1.16-1.22), P<0.001)] were recommended; and a significant decrease in the rate NSAIDs were recommended [annual relative decrease of 4% (RR 0.96 (95% CI 0.95-0.97), P<0.001)]. Logistic regression identified several patient and GP characteristics associated with medicine recommendations, e.g. stronger opioids were less likely recommended for Indigenous patients [odds ratio 0.15 (95% CI 0.04-0.56)]. GP's analgesic recommendations for spinal pain have become increasingly divergent from guideline recommendations over time.