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1.
Health Econ ; 26(1): 54-73, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-26498432

RESUMEN

Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient. This subset of options forms the consideration set from which the ultimate recommendation is made. Given the existence of consideration sets we address the issue of how to model appropriately the ultimate recommendations. The estimated models enable us to characterize doctor recommendations and how they vary with patient attributes and to highlight where recommendations are clear and when they are uncertain. The results also indicate systematic variation in recommendations across different types of doctors, and in particular we observe that some doctors are reluctant to embrace new products and instead recommend those that are more familiar. Such effects are one possible explanation for the relatively low uptake of more cost effective longer acting reversible contraceptives and indicate that further education and training of doctors may be warranted. Copyright © 2015 John Wiley & Sons, Ltd.


Asunto(s)
Anticoncepción/estadística & datos numéricos , Anticonceptivos/uso terapéutico , Médicos , Derivación y Consulta , Adolescente , Adulto , Conducta de Elección , Femenino , Humanos , Salud Reproductiva
2.
Commun Dis Intell Q Rep ; 40 Suppl: S1-70, 2016 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-27087017

RESUMEN

This summary report on vaccine preventable diseases in Australia brings together the 3 most important national sources of routinely collected data on vaccine preventable diseases (notifications, hospitalisations and deaths) for all age groups for the period January 2008 to December 2011. The general trend towards improved control of disease is evident, particularly in the childhood years. Detailed results are available in 16 individual chapters. Although these data have limitations, which are discussed in detail in the body of the report, some clear trends are evident. Compared with the previous review period (2005-2007), there are continuing declines in the overall disease burden, driven by improving control of mumps, rubella, hepatitis B and meningococcal disease. There is an ongoing absence of disease due to polio and a continuing low incidence of tetanus. There have been continuing declines in the incidence of hepatitis A and B. However, there were 4 notified cases of diphtheria in 2011; prior to these reports there had been no notified diphtheria cases since 2001. Influenza and pertussis notifications have increased, whereas notifications and hospitalisations for mumps have remained stable and for meningococcal disease have declined. Influenza, pertussis and pneumococcal disease continue to contribute the greatest burden of serious disease.


Asunto(s)
Control de Enfermedades Transmisibles/estadística & datos numéricos , Enfermedades Transmisibles/epidemiología , Vacunación Masiva/estadística & datos numéricos , Vigilancia en Salud Pública , Vacunas/administración & dosificación , Adolescente , Adulto , Anciano , Australia/epidemiología , Niño , Preescolar , Control de Enfermedades Transmisibles/organización & administración , Enfermedades Transmisibles/inmunología , Enfermedades Transmisibles/microbiología , Enfermedades Transmisibles/virología , Notificación de Enfermedades/estadística & datos numéricos , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad
3.
Value Health ; 16(1): 114-23, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23337222

RESUMEN

OBJECTIVE: Health promotion (HP) interventions have outcomes that go beyond health. Such broader nonhealth outcomes are usually neglected in economic evaluation studies. To allow for their consideration, insights are needed into the types of nonhealth outcomes that HP interventions produce and their relative importance compared with health outcomes. This study explored consumer preferences for health and nonhealth outcomes of HP in the context of lifestyle behavior change. METHODS: A discrete choice experiment was conducted among participants in a lifestyle intervention (n = 132) and controls (n = 141). Respondents made 16 binary choices between situations that can be experienced after lifestyle behavior change. The situations were described by 10 attributes: future health state value, start point of future health state, life expectancy, clothing size above ideal, days with sufficient relaxation, endurance, experienced control over lifestyle choices, lifestyle improvement of partner and/or children, monetary cost per month, and time cost per week. RESULTS: With the exception of "time cost per week" and "start point of future health state," all attributes significantly determined consumer choices. Thus, both health and nonhealth outcomes affected consumer choice. Marginal rates of substitution between the price attribute and the other attributes revealed that the attributes "endurance," "days with sufficient relaxation," and "future health state value" had the greatest impact on consumer choices. The "life expectancy" attribute had a relatively low impact and for increases of less than 3 years, respondents were not willing to trade. CONCLUSIONS: Health outcomes and nonhealth outcomes of lifestyle behavior change were both important to consumers in this study. Decision makers should respond to consumer preferences and consider nonhealth outcomes when deciding about HP interventions.


Asunto(s)
Conducta de Elección , Conductas Relacionadas con la Salud , Promoción de la Salud/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Prioridad del Paciente , Adulto , Toma de Decisiones , Femenino , Estado de Salud , Humanos , Esperanza de Vida , Estilo de Vida , Masculino , Persona de Mediana Edad
4.
Eur J Contracept Reprod Health Care ; 18(3): 181-90, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23557397

RESUMEN

OBJECTIVES: To determine how women and physicians rate individual characteristics of contraceptives. METHODS: Discrete choice experiments are used in health economics to elicit preferences for healthcare products. A choice experiment uses hypothetical scenarios to determine which individual factors influence choice. Women and general practitioners (GPs) were shown individual characteristics of contraceptives, not always matching existing methods, and chose the best and worst features. RESULTS: Two hundred women, mean age 36, 71% using contraception, were presented with descriptions of 16 possible methods and asked to indicate their preference for individual characteristics. One hundred and sixty-two GPs, mostly women, also completed 16 descriptions. Longer duration of action was most favoured by both, followed by lighter periods with less pain or amenorrhoea. The least attractive features for women were heavier and more painful periods, high cost, irregular periods, low efficacy (10% failure) and weight gain of 3 kg. GPs ranked a 10% pregnancy rate as least attractive followed by heavy painful periods and a 5% failure rate. CONCLUSION: Women and GPs differed in their ranking of contraceptive characteristics. Long duration of use, high efficacy, minimal or no bleeding without pain, were preferred by both. Very undesirable were heavy periods especially with pain, and low efficacy.


Asunto(s)
Conducta de Elección , Comportamiento del Consumidor/estadística & datos numéricos , Anticoncepción/psicología , Anticonceptivos/administración & dosificación , Médicos Generales/estadística & datos numéricos , Adolescente , Adulto , Actitud del Personal de Salud , Actitud Frente a la Salud , Anticoncepción/estadística & datos numéricos , Recolección de Datos , Femenino , Humanos , Persona de Mediana Edad , Aceptación de la Atención de Salud , Prioridad del Paciente , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
5.
Value Health ; 14(6): 928-36, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21914515

RESUMEN

BACKGROUND: Cost-utility analyses (CUAs) are increasingly common in Australia. The EuroQol five-dimensional (EQ-5D) questionnaire is one of the most widely used generic preference-based instruments for measuring health-related quality of life for the estimation of quality-adjusted life years within a CUA. There is evidence that valuations of health states vary across countries, but Australian weights have not previously been developed. METHODS: Conventionally, weights are derived by applying the time trade-off elicitation method to a subset of the EQ-5D health states. Using a larger set of directly valued health states than in previous studies, time trade-off valuations were collected from a representative sample of the Australian general population (n = 417). A range of models were estimated and compared as a basis for generating an Australian algorithm. RESULTS: The Australia-specific EQ-5D values generated were similar to those previously produced for a range of other countries, but the number of directly valued states allowed inclusion of more interaction effects, which increased the divergence between Australia's algorithm and other algorithms in the literature. CONCLUSION: This new algorithm will enable the Australian community values to be reflected in future economic evaluations.


Asunto(s)
Estado de Salud , Calidad de Vida , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Algoritmos , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Método de Montecarlo , Factores Socioeconómicos , Factores de Tiempo , Adulto Joven
6.
Health Econ ; 20 Suppl 1: 35-52, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21809412

RESUMEN

New contraceptive methods provide greater choice in terms of effectiveness, management of side-effects, convenience and frequency of administration and flexibility, but make the decisions about contraception more complex. There are limited data on the factors that determine women's choices among these alternatives, to inform providers about the factors which are most important to women, or to predict uptake of new products. This paper reports on a choice experiment designed to elicit women's preferences in relation to prescribed contraception and to forecast the impact of the introduction of two new products into the Australian market. A generalised multinomial logit model is estimated and used in the simulation exercise. The model forecasts that the hormonal patch would be well received among women, achieving a greater market share than current non-pill products, but the vaginal ring would have limited appeal.


Asunto(s)
Conducta de Elección , Anticoncepción/métodos , Anticoncepción/psicología , Prioridad del Paciente/psicología , Acné Vulgar/inducido químicamente , Adolescente , Adulto , Australia , Peso Corporal , Anticoncepción/economía , Anticonceptivos Femeninos/economía , Anticonceptivos Femeninos/uso terapéutico , Dispositivos Anticonceptivos Femeninos/economía , Dispositivos Anticonceptivos Femeninos/estadística & datos numéricos , Vías de Administración de Medicamentos , Esquema de Medicación , Femenino , Humanos , Persona de Mediana Edad , Modelos Econométricos , Honorarios por Prescripción de Medicamentos , Factores Socioeconómicos , Adulto Joven
7.
Qual Life Res ; 18(5): 637-45, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19330463

RESUMEN

PURPOSE: Cross-sectional surveys depend on retrospective health transition questions (HTQ) to estimate recent changes in health status. This paper assesses the validity of the SF-36 HTQ and calibrates its categories against change assessed prospectively on the SF-36 domain scales in a sub-group known to have experienced clinically important changes in health status. METHODS: Adults (n = 9,649) from a longitudinal population survey completed the SF-36 in 2001 and 2002. Prospective measures were calculated as mean changes in SF-36 scale scores adjusted for age and gender, and also expressed as standardised response means. Comparison groups were those who had developed a long-term health condition since the last interview and the HTQ response categories for those who had not developed any new conditions. RESULTS: Those with a new condition and those without a new condition but who described their health as "somewhat worse" than a year ago had comparable declines in health status on all domain scales except role physical, where those with a new condition experienced a greater decline. CONCLUSIONS: This analysis demonstrates the validity and limitations of the HTQ as a measure of change in population studies. The calibration is useful for interpreting the meaning of the HTQ categories at the group level but not at the individual level.


Asunto(s)
Indicadores de Salud , Encuestas y Cuestionarios/normas , Adulto , Australia/epidemiología , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Recuerdo Mental , Persona de Mediana Edad
8.
J Paediatr Child Health ; 44(12): 699-705, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19077068

RESUMEN

AIM: To describe the nature of the encounters between adolescents and general practice in Australia. METHODS: Data collected by the Bettering the Evaluation and Care of Health programme from 1998-2004 were analysed. Data for 10-14-year-old and 15-19-year-old males and females were compared with data for 25-29-year-olds. The outcome measures included: number of encounters compared with other age groups, reasons for encounter, problems managed, treatments prescribed and referrals made for key problems and types of consultations. RESULTS: Adolescents have the lowest rate of encounter with general practice, compared with all other age groups. Respiratory, skin, musculoskeletal and unspecified (fever, injury, weakness) problems accounted for the great majority of reasons for encounter and problems managed. Management of mental health problems, preventive health care and health education were very infrequently managed problems. Standard surgery consultations were more common among adolescents than among young adults. CONCLUSIONS: Adolescents have a relatively low rate of encounter with general practice and the problems managed are primarily physical ailments. There is great scope to improve delivery of preventive health care and to increase management of mental health problems.


Asunto(s)
Medicina Familiar y Comunitaria , Servicios de Salud/estadística & datos numéricos , Adolescente , Adulto , Australia , Niño , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Adulto Joven
9.
Pediatr Infect Dis J ; 26(8): 689-92, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17848879

RESUMEN

BACKGROUND: Indigenous children have the highest reported prevalence and severity of otitis media in the world, but whether their clinical management varies accordingly is unknown. METHODS: Using a representative Australia-wide cluster survey of consecutive primary healthcare consultations, we compared practitioners' investigation, treatment, and referral practices for otitis media in indigenous and nonindigenous children (0-18 years), after adjusting for clustering. RESULTS: Over 8 years (1998-2006), 7991 practitioners managed 141,693 problems during 119,503 consultations with children, including 2856 (2%) with indigenous children. Ear problems were the fourth most common problems managed overall, with otitis media seen more commonly in indigenous than in nonindigenous children (10% versus 7% consultations, P < 0.001). Indigenous children were significantly more likely to have severe otitis media (chronic and/or suppurative and/or perforation, 8% versus 2%, P < 0.001); discharging ears (4% versus 0.1%, P < 0.001); ear swabs [4%, 95% confidence interval (CI): 2%-6% versus 0.8%, 95% CI: 0.6%-0.9%]; and topical eardrops administered (11%, 95% CI: 7%-15% versus 5%, 95% CI: 4%-5%); but not more likely to receive oral antibiotics (72% versus 76%); have ear syringing (1% versus 0.2%); be referred to an otolaryngologist (6% versus 3%) or audiologist (2% versus 1%); all P > 0.05. CONCLUSIONS: In the Australian primary healthcare setting, indigenous children are 5 times more likely to be diagnosed with severe otitis media than nonindigenous children, but reported management is not substantially different, which is inconsistent with established national guidelines. This spectrum-management discordance may contribute to continued worse outcomes for indigenous children with otitis media.


Asunto(s)
Otitis Media/epidemiología , Otitis Media/terapia , Grupos Raciales , Adolescente , Antibacterianos/uso terapéutico , Australia , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Masculino , Otitis Media con Derrame/epidemiología , Prevalencia , Derivación y Consulta/estadística & datos numéricos
10.
Aust Health Rev ; 31(3): 440-8, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17669067

RESUMEN

INTRODUCTION: Medical workforce shortages in Australia have led to increasing reliance on overseas-trained doctors (OTDs) to work in general practice in areas of need, particularly in rural areas. These OTDs do not have Australian postgraduate training in general practice, and we know little about how they practise. OBJECTIVE: To determine differences in practice style between a self-selected group of overseas-trained general practitioners undertaking the Alternative Pathways Program and GPs who are Fellows of the Royal Australian College of General Practitioners (FRACGP), and whether such differences can be explained by other practitioner, practice and patient characteristics. METHOD: A self-selected sample of 89 OTDs from the Alternative Pathways Program were compared with FRACGPs in a continuous national study of GP activity (n=1032). Each GP provided details about themselves and their practice and recorded data about patients, morbidity and treatments for 100 encounters. RESULTS: OTDs were younger, less experienced, worked more sessions per week, in smaller practices. OTDs saw fewer children and elderly patients, more new patients, health concession card holders and Indigenous people. OTDs managed less general, urological, social, skin and pregnancy problems, and more cardiovascular problems, urinary tract infections, tonsillitis and conjunctivitis. They provided more medications, other treatments and referrals, and ordered more pathology and imaging tests. CONCLUSION: This study suggests that OTDs see a different patient mix and range of morbidity and provide different management to that of FRACGPs, generating higher costs of care. Regular study of the clinical activities of a representative sample of overseas-trained GPs is needed.


Asunto(s)
Medicina Familiar y Comunitaria , Médicos Graduados Extranjeros/provisión & distribución , Pautas de la Práctica en Medicina , Adolescente , Adulto , Anciano , Australia/epidemiología , Grupos Diagnósticos Relacionados , Medicina Familiar y Comunitaria/estadística & datos numéricos , Médicos Graduados Extranjeros/normas , Humanos , Persona de Mediana Edad , Morbilidad , Administración de la Práctica Médica , Encuestas y Cuestionarios , Recursos Humanos
11.
Aust Fam Physician ; 35(11): 925-8, 2006 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17099818

RESUMEN

INTRODUCTION: Patients' self perception of weight status is a factor to be considered before an attempt is made by the clinician to initiate weight loss behaviour. METHOD: We compared the weight self assessment of 1973 general practice patients to their body mass index (BMI). Patients also ranked the success of any weight loss methods they had tried. General practitioners recorded the patients' type 2 diabetes status and this was analysed by BMI group. RESULTS: Overweight/obese patients accounted for 56.6% of the sample. Forty percent of overweight and 12.5% of obese patients did not see themselves as overweight. Close to 40% of patients had attempted to lose weight in the previous year. Diet/ exercise was the most common and successful weight loss method. There was a significantly higher prevalence of type 2 diabetes among obese patients. DISCUSSION: Despite some positive results on weight loss attempts, a considerable proportion of overweight and some obese patients do not perceive themselves as being overweight.


Asunto(s)
Imagen Corporal , Diabetes Mellitus Tipo 2/epidemiología , Autoimagen , Pérdida de Peso , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso , Prevalencia , Delgadez/epidemiología
12.
Aust Fam Physician ; 35(9): 668-9, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16969432

RESUMEN

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of encounters at which postnatal depression was managed. This provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.


Asunto(s)
Depresión Posparto/epidemiología , Depresión Posparto/terapia , Medicina Familiar y Comunitaria/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Antidepresivos/uso terapéutico , Australia/epidemiología , Consejo/estadística & datos numéricos , Depresión Posparto/diagnóstico , Femenino , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad , Embarazo , Derivación y Consulta/estadística & datos numéricos
14.
Drug Alcohol Rev ; 24(6): 499-506, 2005 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-16361206

RESUMEN

The aim of this study was to document the frequency of the management of illicit drug, alcohol and tobacco problems in general practice in Australia. Data from the Bettering the Evaluation and Care of Health (BEACH) study of general practice, April 1998 to March 2003, were analysed. BEACH is an ongoing national study of general practice in Australia. Each year a random sample of approximately 1000 general practitioners (GPs) participate, each providing details of 100 patient encounters. Samples are drawn from the Medicare data held by the Health Insurance Commission. Patient demographic breakdowns, medication, other treatment, referrals and other medical procedures ordered were examined for all problems labelled by GPs as illicit, alcohol and tobacco problems. Annually in Australia, it was estimated that 615,000 GP encounters--or 0.6% of all encounters--involved the management of illicit drug use problems presumably most commonly for problematic heroin use. Despite a much higher population prevalence of use and use disorders, the management of alcohol or tobacco use problems was less common, with 0.4% and 0.3% of encounters, respectively, comprising treatment of these problems. Clear demographic differences existed across the groups. The management of problems also differed, with illicit drug use problems more likely to involve provision of medication, and alcohol and tobacco treatment more likely to involve counselling and/or health advice. Despite higher rates of alcohol and tobacco use problems among patients seeing GPs in Australia, the rate of treatment for such problems was relatively lower than it was for illicit drug use problems. More efforts need to be directed towards assisting GPs to identify and target problematic alcohol and tobacco use among their patients.


Asunto(s)
Alcoholismo/terapia , Médicos de Familia , Atención Primaria de Salud , Tabaquismo/terapia , Adolescente , Adulto , Australia , Estudios Transversales , Femenino , Humanos , Drogas Ilícitas , Masculino , Persona de Mediana Edad , Derivación y Consulta
15.
Aust Fam Physician ; 34(10): 810-1, 2005 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16217563

RESUMEN

The BEACH program, a continuous national study of general practice activity in Australia, gives an overview of consultations with indigenous patients. Between 1998 and 2003, general practitioners recorded 5476 consultations with people who identified themselves as being of Aboriginal and/or Torres Strait Islander origin. These accounted for approximately 1% of total BEACH encounters for the 5 year period. In this article we compare 'indigenous encounters' with total BEACH encounters. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.


Asunto(s)
Medicina Familiar y Comunitaria/estadística & datos numéricos , Morbilidad , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Australia/epidemiología , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Servicios de Salud del Indígena , Humanos , Masculino , Derivación y Consulta/estadística & datos numéricos
16.
J Health Econ ; 43: 118-27, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26232651

RESUMEN

This study uses a discrete choice experiment (DCE) to measure patients' preferences for public and private hospital care in New Zealand. A labeled DCE was administered to 583 members of the general public, with the choice between a public and private hospital for a non-urgent surgery. The results suggest that cost of surgery, waiting times for surgery, option to select a surgeon, convenience, and conditions of the hospital ward are important considerations for patients. The most important determinant of hospital choice was whether it was a public or private hospital, with respondents far more likely to choose a public hospital than a private hospital. The results have implications for government policy toward using private hospitals to clear waiting lists in public hospitals, with these results suggesting the public might not be indifferent to policies that treat private hospitals as substitutes for public hospitals.


Asunto(s)
Procedimientos Quirúrgicos Electivos/normas , Hospitales Privados/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Prioridad del Paciente/psicología , Adolescente , Adulto , Distribución por Edad , Conducta de Elección , Costos y Análisis de Costo , Procedimientos Quirúrgicos Electivos/economía , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Cálculos Biliares/economía , Cálculos Biliares/cirugía , Encuestas de Atención de la Salud , Hospitales Privados/economía , Hospitales Privados/normas , Hospitales Públicos/economía , Hospitales Públicos/normas , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Prioridad del Paciente/economía , Prioridad del Paciente/estadística & datos numéricos , Distribución por Sexo , Factores de Tiempo , Listas de Espera , Adulto Joven
17.
BMC Med Res Methodol ; 4(1): 30, 2004 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-15613248

RESUMEN

BACKGROUND: Cluster sample study designs are cost effective, however cluster samples violate the simple random sample assumption of independence of observations. Failure to account for the intra-cluster correlation of observations when sampling through clusters may lead to an under-powered study. Researchers therefore need estimates of intra-cluster correlation for a range of outcomes to calculate sample size. We report intra-cluster correlation coefficients observed within a large-scale cross-sectional study of general practice in Australia, where the general practitioner (GP) was the primary sampling unit and the patient encounter was the unit of inference. METHODS: Each year the Bettering the Evaluation and Care of Health (BEACH) study recruits a random sample of approximately 1,000 GPs across Australia. Each GP completes details of 100 consecutive patient encounters. Intra-cluster correlation coefficients were estimated for patient demographics, morbidity managed and treatments received. Intra-cluster correlation coefficients were estimated for descriptive outcomes and for associations between outcomes and predictors and were compared across two independent samples of GPs drawn three years apart. RESULTS: Between April 1999 and March 2000, a random sample of 1,047 Australian general practitioners recorded details of 104,700 patient encounters. Intra-cluster correlation coefficients for patient demographics ranged from 0.055 for patient sex to 0.451 for language spoken at home. Intra-cluster correlations for morbidity variables ranged from 0.005 for the management of eye problems to 0.059 for management of psychological problems. Intra-cluster correlation for the association between two variables was smaller than the descriptive intra-cluster correlation of each variable. When compared with the April 2002 to March 2003 sample (1,008 GPs) the estimated intra-cluster correlation coefficients were found to be consistent across samples. CONCLUSIONS: The demonstrated precision and reliability of the estimated intra-cluster correlations indicate that these coefficients will be useful for calculating sample sizes in future general practice surveys that use the GP as the primary sampling unit.


Asunto(s)
Medicina Familiar y Comunitaria/estadística & datos numéricos , Encuestas de Atención de la Salud/métodos , Morbilidad , Australia/epidemiología , Análisis por Conglomerados , Estudios Transversales , Demografía , Femenino , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Masculino , Variaciones Dependientes del Observador , Pacientes Ambulatorios/clasificación , Pacientes Ambulatorios/estadística & datos numéricos
18.
BMC Health Serv Res ; 4(1): 8, 2004 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-15142280

RESUMEN

BACKGROUND: The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties. METHODS: A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice. RESULTS: A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists. CONCLUSION: Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging classification system in the public domain, we invite comment and application in other settings where similar problems might be faced.


Asunto(s)
Enfermedad/clasificación , Atención Primaria de Salud/organización & administración , Especialidades Quirúrgicas/organización & administración , Procedimientos Quirúrgicos Operativos/clasificación , Australia , Current Procedural Terminology , Femenino , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Comunicación Interdisciplinaria , Clasificación Internacional de Enfermedades , Masculino , Pautas de la Práctica en Medicina , Atención Primaria de Salud/clasificación , Probabilidad , Derivación y Consulta/estadística & datos numéricos , Especialidades Quirúrgicas/clasificación
19.
BMC Fam Pract ; 5: 17, 2004 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-15318948

RESUMEN

BACKGROUND: Understanding the factors that affect patients' utilisation of health services is important for health service provision and effective patient management. This study aimed to investigate the specific morbidity and demographic factors related to the frequency with which general practice patients visit a general practitioner/family physician (GP) in Australia. METHODS: A sub-study was undertaken as part of an ongoing national study of general practice activity in Australia. A cluster sample of 10,755 general practice patients were surveyed through a random sample of 379 general practitioners. The patient reported the number of times he/she had visited a general practitioner in the previous twelve months. The GP recorded all the patient's major health problems, including those managed at the current consultation. RESULTS: Patients reported an average of 8.8 visits to a general practitioner per year. After adjusting for other patient demographics and number of health problems, concession health care card holders made on average 2.6 more visits per year to a general practitioner than did non-card holders (p <.001). After adjustment, patients from remote/very remote locations made 2.3 fewer visits per year than patients from locations where services were highly accessible (p <.001). After adjustment for patient demographics, patients with diagnosed anxiety made on average 2.7 more visits per year (p = 0.003), those with diagnosed depression 2.2 more visits than average (p <.0001), and those with back problems 2.4 more visits (p = 0.009) than patients without the respective disorders. CONCLUSIONS: Anxiety, back pain and depression are associated with greater patient demand for general practice services than other health problems. The effect of sociodemographic factors on patient utilisation of general practice services is complex. Equity of access to general practice services remains an issue for patients from remote areas, while concession health care card holders are attending general practice more frequently than other patients relative to their number of health problems.


Asunto(s)
Medicina Familiar y Comunitaria/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Morbilidad , Visita a Consultorio Médico/estadística & datos numéricos , Adolescente , Adulto , Anciano , Australia/epidemiología , Enfermedad Crónica/epidemiología , Estudios Transversales , Demografía , Medicina Familiar y Comunitaria/economía , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Humanos , Seguro de Servicios Médicos/estadística & datos numéricos , Masculino , Área sin Atención Médica , Persona de Mediana Edad , Programas Nacionales de Salud/estadística & datos numéricos , Salud Rural
20.
ANZ J Surg ; 74(10): 863-8, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15456434

RESUMEN

BACKGROUND: Optimal planning for surgical training and the surgical workforce requires knowledge of the need and demand for surgical care in the community. This has previously relied on indirect indicators, such as hospital throughput. We aimed to describe referrals from general practitioners (GPs) to surgeons in Australia using a classification of surgical disorders developed especially for primary care settings. METHODS: Terms in the International Classification of Primary Care Version 2-Plus were reclassified into categories delineated by specialist surgeons, resulting in the Surgical Nosology In Primary-care Settings (SNIPS). Referrals to surgeons were analysed using data on 303,000 patient encounters by a random sample of 3030 GPs involved in the Bettering the Evaluation and Care of Health (BEACH) study. RESULTS: Thirty-two per cent (143,013) of all problems were classified as potential surgical problems, of which 9.5% (13,570) were referred to surgeons at an overall rate of 44.8 referrals per 1000 GP encounters. Patients with surgical problems were significantly older than the overall general practice patient population. Women and patients with health care cards were significantly less likely than men and patients without health care cards to be referred when a surgical problem was managed by the GP. Forty-two per cent of all surgical referrals were accounted for by the following categories: skin lesions, skin infection/injury, upper gastrointestinal, breast lumps/cancer, spine, knee arthritis/pain, knee injury/instability, infective and non-infective ear disorders. Many commonly referred problems are usually managed as outpatients. CONCLUSIONS: The data from this study may have application for surgical workforce planning and ensuring trainees receive adequate exposure to commonly referred conditions. The classification system (SNIPS) may be useful for future research concerning the interface between primary care and specialist surgical practice.


Asunto(s)
Medicina Familiar y Comunitaria , Cirugía General/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adolescente , Adulto , Anciano , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad
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