The management of chronic problems.

There were 36 805 encounters where at least one chronic problem was managed in 2006-2007, at a rate of 51.8 chronic problems per 100 encounters. Nationally, this equates to over 40 million general practice encounters at which chronic problems were managed in Australia. For males, at least one chronic problem was managed at 40.7% of encounters. There was no significant difference in the proportion of encounters that involved management of chronic problems between males (40.7%) and females (38.7%).

EPC encounters in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of the content of Enhanced Primary Care (EPC) encounters in Australian general practice. The EPC program was introduced on 1 November 1999, and contained three major aspects of care--health assessments, care plans and case conferences.

Current status of hormone therapy in general practice in Australia.

The BEACH program is a continuous national study of general practice activity in Australia. The subject of this analysis was all problems for which a hormone therapy years (HT) medication was prescribed or supplied at HT encounters with women aged 40 and over between March 2002 and April 2004. This provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.

General practitioner consultations at residential aged-care facilities.

OBJECTIVES: To describe the patients seen and the clinical activity undertaken by general practitioners during encounters at residential aged-care facilities (RACFs), and to ascertain how these differ from all GP encounters in Australia as a whole. DESIGN AND PARTICIPANTS: A secondary analysis of encounter data from the Bettering the Evaluation and Care of Health (BEACH) study, April 2004 to March 2006, comparing RACF consultations (identified by Medicare item numbers) with all BEACH study encounters in Australia. Participants were a random sample of GPs who had claimed at least 375 general practice Medicare items in the 3 months prior to the study. MAIN OUTCOME MEASURES: Differences in the characteristics of GPs and patients at RACF consultations, morbidities managed, and treatments provided to patients. RESULTS: Over the study period there were 2310 RACF encounters out of a total of 197 000 BEACH encounters; 360/1970 GPs (18.4%) recorded at least one RACF consultation. GPs aged > or = 45 years were more likely to record at least one RACF consultation than those aged < 45 years. Patients were predominantly women (70.7%), and 83.4% were aged > or = 75 years. At RACF consultations, problems managed significantly more often included chronic problems, as well as psychological, neurological, urological, circulatory, eye and musculoskeletal problems. Dementia was the most common problem managed, at 33 times the usual management rate in everyday practice. Significantly fewer medications, non-pharmacological treatments, referrals, pathology and imaging tests were recorded at RACF consultations. CONCLUSION: GP encounters at RACFs involve the management of chronic and complex conditions, including some not frequently seen in everyday general practice. The provision of additional education and resources where required may assist with workforce shortages in this setting.

Defining chronic conditions for primary care with ICPC-2.

BACKGROUND: With the increasing prevalence of chronic conditions, there is need for a standardized definition of chronicity for use in research, to evaluate the population prevalence and general practice management of chronic conditions. OBJECTIVES: Our aims were to determine the characteristics required to define chronicity, apply them to a primary care classification and provide a defined codeset of chronic conditions. METHODS: A literature review evaluated characteristics used to define chronic conditions. The final set of characteristics was applied to the International Classification of Primary Care-Version 2 (ICPC-2) through more specific terms available in ICPC-2 PLUS, an extended terminology classified to ICPC-2. A set of ICPC-2 rubrics was delineated as representing chronic conditions. RESULTS: Factors found to be relevant to a definition of chronic conditions for research were: duration; prognosis; pattern; and sequelae. Within ICPC-2, 129 rubrics were described as 'chronic', and another 20 rubrics had elements of chronicity. Duration was the criterion most frequently satisfied (98.4% of chronic rubrics), while 88.2% of rubrics met at least three of the four criteria. CONCLUSION: Monitoring the prevalence and management of chronic conditions is of increasing importance. This study provided evidence for multifaceted definitions of chronicity. While all characteristics examined could be used by those interested in chronicity, the list has been designed to identify chronic conditions managed in Australian general practice, and is therefore not a nomenclature of all chronic conditions. Subsequent analysis of chronic conditions using pre-existing data sets will provide a baseline measure of chronic condition prevalence and management in general practice.