Comorbidities and risk factors among patients with schizophrenia.

General practitioners (GPs) are charged with maintaining a holistic approach to their patients' health. While most patients with schizophrenia attend public mental health services and/or non-government organisations supporting people with mental illness, 88.2% of people with a psychotic illness (the majority being schizophrenia or schizoaffective disorder) had visited a GP in the previous year. For at least 30-40% of people living with schizophrenia in Australia, ongoing management is provided by their GP alone. Moreover, there is evidence that patients with schizophrenia value the help provided by GPs. Patients with schizophrenia have reduced life expectancy. Overseas research (primarily from the UK and US) has found that the poor physical health of patients with schizophrenia can be attributed to a number of factors such as modifiable lifestyle risk factors and side effects of medication, compounded by causes intrinsic to the illness such as mental stress and loss of initiative.

'The kids are alright' - Changes in GP consultations with children 2000-15.

The ageing of Australia's population has led to a focus on the health resources required for older patients, and there has been concern that this might be at the expense of children's healthcare. Over the past few decades the number of children in Australia has increased, but has steadily declined as a proportion of the population. This has paralleled an increase in the absolute number of general practitioner (GP) encounters with children aged <15 years, but a decline in the percentage of GP workload from 14.3% in 2000-01 to 11.2% in 2013-14. There are disparities in the use of general practice services by age, with children making up a greater proportion of the population (19.3%) than of GP visits (13.0%), while people aged 65 years and older accounted for 13.0% of the population and 26.5% of visits in 2006. It is unclear whether the decline in the proportion of GP workload accounted for by children reflects a change in the way children use these general practice services, or a redistribution based on the ageing of the patient population. Over time, there have been marked changes in the types of problems managed in children. From the 1990s to 2001, Australia's children became well vaccinated and decreasingly likely to have 'traditional' childhood illnesses (notably infections). More recently, there has been significant growth in the management of child mental health problems in general practice, although mental health problems account for a small proportion of childhood problems managed. We examined children's use of general practice services and the problems managed in 2000-03 and 2012-15 to determine whether their service use has been influenced by the demands associated with the management of older Australians, and whether trends in problems managed identified in early studies have continued.

Management of childhood asthma in general practice.

BACKGROUND: Inhaled corticosteroids (ICS) are recommended for children with moderate or severe persistent asthma. The aims of this paper were to determine changes in childhood asthma management rates between 2004-14, and to examine current medication use and level of control in children attending general practice. METHODS: National BEACH data were used to investigate childhood (<15 years) asthma management rate. Prevalence, medication use and asthma control (Global Initiative for Asthma guidelines) were recorded for a subset of children. RESULTS: The management rate did not change over time. Prevalence was 13.7%. ICS were taken by 42.8% of children. Asthma was well controlled for 51.8%, partly controlled for 30.4% and uncontrolled for 17.9% of children. This study highlights the need to monitor appropriate medication use, particularly ICS/long-acting ß-agonist use, for asthma control in children.

Post-traumatic stress disorder in veterans.

Over 2000 general practice encounters per year (2.3%) in BEACH are with repatriation health card holders, referred to here as veterans. The patients are veterans of Australia's defence force or war widows, widowers or dependent children. We compared the rate at which post-traumatic stress disorder (PTSD) was managed among veterans and non-veterans from April 2009 to June 2014.

Chronic skin ulcers.

A rapid rise in the treatment of chronic wounds in the United States has been linked to an ageing population and an increasing incidence of diabetes and obesity. In Australia, we also have an ageing population, and increases in the prevalence of obesity and in the management rate of type 2 diabetes.

Tobacco smoking.

Worldwide, 22% of adults aged ≥15 years currently smoke tobacco. Up to half of current smokers will eventually die of a tobacco-related disease, and smoking is the leading cause of ill health, drug-related death and hospital separations in Australia.

Cardiomyopathy.

Cardiomyopathy is a disease that causes the heart muscle to become weak and ineffective, reducing the heart's ability to pump blood through the body and possibly leading to heart failure. The rate at which cardiomyopathy was recorded by general practitioner (GP) participants in the BEACH program has not changed significantly since 2000. On average, it was managed at 0.9 per 1000 encounters between April 2000 and March 2013, a total of 1175 times over that period. In 9 out of 10 cases, GPs used the general term cardiomyopathy, whereas in the other 10% this was specified as hypertrophic, congestive, secondary or restrictive.

Paediatric psychological problems.

A 2011 BEACH-based study showed that over the past 40 years there has been increasing general practitioner (GP) involvement in the management of paediatric mental health in Australia. There has also been a changing mix of psychological conditions managed, including increased management of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).

Rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by joint swelling, joint tenderness and destruction of synovial joints, leading to severe disability. RA is considered an autoimmune disease. A study in the UK found the population minimum prevalence of RA is 1.16% in women and 0.44% in men. In Australia, the estimated prevalence is 0.6%. Using BEACH data from April 2011 to March 2013, we examined the rate of RA and its management in Australian general practice.

Globus hystericus.

Globus hystericus (GH) is a subjective feeling of a lump or foreign body in the throat thought to involve psychogenic factors, a form of somatisation disorder. The more modern terms, globus sensation or globus pharyngeus, reflect recognition of one or more possible contributing anatomico-physiological factors, such as gastro-oesophageal reflux disease (GORD) or pharyngeal inflammation.

Better Outcomes or Better Access -- which was better for mental health care?

OBJECTIVE: To compare the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative with the Better Outcomes in Mental Health Care initiative, to test contentions that Better Access is used more often by advantaged major city patients and that the role of GPs has been reduced to that of referrers. DESIGN AND SETTING: Analysis of Bettering the Evaluation and Care of Health data relating to management of depression from April 1998 to March 2011, with the Better Outcomes period defined as January 2002 to October 2006 and the Better Access period defined as November 2006 to December 2011. MAIN OUTCOME MEASURES: Rates of depression management by GPs, including rates of mental health care item claims, referrals, prescribing and counselling, by patient location and socioeconomic group. RESULTS: During the study period, rates of depression management increased and rates of referrals to psychiatrists halved. Compared with Better Outcomes, Better Access resulted in: increased depression management for advantaged major city and disadvantaged non-major city patients (16.0% and 21.5% increases, respectively); a small decrease in prescribing for advantaged major city patients; decreases in GP counselling; increases in referrals to psychologists for all patient groups (three- to fourfold increases), with advantaged major city patients referred more often than patients in other groups; and increases in mental health care item claims for all patient groups (44-65-fold increases), with more claims for advantaged major city patients than both non-major city patient groups. CONCLUSION: Far from becoming "glorified referrers", GPs remain heavily involved in the management of depression. Better Access brought about an enormous increase in access to primary care management of depression, although advantaged major city patients gained most. Any changes to the system must not compromise the strong improvements in access that have occurred for all groups.

GPs in teaching practices.

From April 2010 to March 2011, 956 general practitioners took part in BEACH (Bettering the Evaluation and Care of Health). Five hundred and ninety-four (62%) worked in a teaching practice for undergraduates, junior doctors or general practice registrars.

Osteoporosis.

From April 2010 to March 2011 in BEACH, osteoporosis was managed at a rate of 6 per 1000 general practice encounters, suggesting an average 708,000 osteoporosis patient-doctor encounters per year nationally.

Chronic problems.

The ageing Australian population will have an impact on general practice, with previous research showing that older patients use more of general practitioners' time than younger age groups. We suggest that the underlying reason for longer consultations with older patients is largely due to the increase in number of chronic conditions managed as patients grows older.

Referrals to A&E--changes over 5 years.

In July 2008, using 2003 to 2007 data from BEACH (Bettering the Evaluation and Care of Health), we published an article in this journal about patients attending general practice who were referred to hospital accident and emergency departments (A&E).(1) The precise referral rate at that time was 1.85 per 1000 encounters (95% CI: 1.70-1.99). A new analysis using recent data shows that in 2008 to 2011 the general practice referral rate to A&E was significantly higher: 2.70 per 1000 encounters (95% CI: 2.48-2.92).

Psychological encounters in general practice.

In November 2001, Focussed Psychological Strategy (FPS) Medicare item numbers were created under the Better Outcomes in Mental Health Care initiative to reimburse general practitioners trained in the provision of evidence based psychological therapies.

Infants-- encounters and management in general practice.

At a BEACH (Bettering the Evaluation and Care of Health) consultation, up to three patient reasons for attending the encounter (RFE) and up to four diagnoses/problems managed can be recorded by the general practitioner. When there are multiple RFE and problems managed at an encounter, there is no direct link between the two. However, there is a direct association between the problem and its management. Medications can be recorded as prescribed, supplied or advised for over-the-counter purchase.

Sprains and strains.

From April 2010 to March 2011 in BEACH (Bettering the Evaluation and Care of Health), sprains and strains were managed at a rate of 14 per 1000 encounters, suggesting an average 1.7 million sprain/strain patient-doctor encounters nationally per year.

Management of nonmelanoma skin cancers.

From April 2010 to March 2011 in BEACH (Bettering the Evaluation and Care of Health), nonmelanoma skin cancers (NMSCs) were managed at one in 100 encounters, suggesting about 1.2 million NMSC patient-doctor encounters nationally in that year.

Sex of the GP--20 years on.

OBJECTIVE: Previous research with the Australian Morbidity and Treatment Survey (1990-1991) showed significant differences in general practitioner characteristics and patient mix of male and female GPs. Even after adjusting for these, it was seen that male and female GPs managed different types of medical conditions. The proportion of female GPs increased from 19.6% in 1990-1991 to 37.1% in 2009-2010. This study investigates whether differences remain two decades later. DESIGN AND SETTING: Analysis of 2009-2010 Bettering the Evaluation and Care of Health (BEACH) data examining GP characteristics, patient encounter characteristics, patient reasons for encounter (RFE), problem types managed and management methods used, by GP sex. Whether GP sex was an independent predictor of problem types being managed, or management methods used, was tested using multiple logistic regressions and Poisson regression. PARTICIPANTS: 988 GPs recorded 98 800 GP-patient encounters. MAIN OUTCOME MEASURE: Adjusted differences in clinical activity of male and female GPs. RESULTS: After adjustment, compared with male GPs, females recorded more RFEs about general and unspecified issues and endocrine, female genital, pregnancy and family planning problems; and fewer concerning the musculoskeletal, respiratory, skin and male genital systems. Female GPs managed more general and unspecified, digestive, circulatory, psychological, endocrine, female genital and social problems; recorded nearly 20% more clinical treatments and referrals; recorded nearly 10% more imaging and pathology tests; and 4.3% fewer medications. CONCLUSIONS: After two decades, even with increased numbers of female GPs, the differences in problems managed by male and female GPs remain, and will probably continue. Female GPs use more resources per encounter, but may not use more resources in terms of annual patient care.