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2.
Aust Health Rev ; 44(2): 328-333, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31639322

RESUMO

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.

3.
BMC Fam Pract ; 20(1): 28, 2019 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764778

RESUMO

BACKGROUND: The 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. METHODS: Between 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. RESULTS: Number 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. CONCLUSIONS: Number 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.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Múltiplas Afecções Crônicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália , Criança , Pré-Escolar , Estudos Transversais , Feminino , Planejamento em Saúde , Mão de Obra em Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
4.
Health Inf Manag ; 48(1): 3-11, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30278786

RESUMO

BACKGROUND:: Electronic medical records are increasingly used for research with limited external validation of their data. OBJECTIVE:: 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. METHOD:: 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. RESULTS:: 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%). DISCUSSION:: While complex, proxy variables can improve usefulness of EMD for research. Without their consideration, EMD results should be interpreted with caution. CONCLUSION:: Enforceable, transparent data linkages in EMRs would resolve many problems with identification of diagnoses. Ongoing data quality improvement remains essential.


Assuntos
Diabetes Mellitus/diagnóstico , Registros Eletrônicos de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Árvores de Decisões , Diabetes Mellitus/epidemiologia , Feminino , Medicina Geral , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
6.
PLoS One ; 12(3): e0172935, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28278241

RESUMO

OBJECTIVES: To estimate the prevalence of common chronic conditions and multimorbidity among patients at GP encounters and among people in the Australian population. To assess the extent to which use of each individual patient's GP attendance over the previous year, instead of the average for their age-sex group, affects the precision of national population prevalence estimates of diagnosed chronic conditions. DESIGN, SETTING AND PARTICIPANTS: A sub-study (between November 2012 and March 2016) of the Bettering the Evaluation and Care of Health program, a continuous national study of GP activity. Each of 1,449 GPs provided data for about 30 consecutive patients (total 43,501) indicating for each, number of GP attendances in previous year and all diagnosed chronic conditions, using their knowledge of the patient, patient self-report, and patient's health record. RESULTS: Hypertension (26.5%) was the most prevalent diagnosed chronic condition among patients surveyed, followed by osteoarthritis (22.7%), hyperlipidaemia (16.6%), depression (16.3%), anxiety (11.9%), gastroesophageal reflux disease (GORD) (11.3%), chronic back pain (9.7%) and Type 2 diabetes (9.6%). After adjustment, we estimated population prevalence of hypertension as 12.4%, 9.5% osteoarthritis, 8.2% hyperlipidaemia, 8.0% depression, 5.8% anxiety and 5.2% asthma. Estimates were significantly lower than those derived using the previous method. About half (51.6%) the patients at GP encounters had two or more diagnosed chronic conditions and over one third (37.4%) had three or more. Population estimates were: 25.7% had two or more diagnosed chronic conditions and 15.8% had three or more. CONCLUSIONS: Of the three approaches we have tested to date, this study provides the most accurate method for estimation of population prevalence of chronic conditions using the GP as an expert interviewer, by adjusting for each patient's reported attendance.


Assuntos
Doença Crônica/epidemiologia , Medicina Geral , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Depressão/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Prevalência , Inquéritos e Questionários , Adulto Jovem
7.
Health Inf Manag ; 46(2): 51-57, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27733648

RESUMO

BACKGROUND: Electronic medical data (EMD) from electronic health records of general practice computer systems have enormous research potential, yet many variables are unreliable. OBJECTIVE: The aim of this study was to compare selected data variables from general practice EMD with a reliable, representative national dataset (Bettering the Evaluation and Care of Health (BEACH)) in order to validate their use for primary care research. METHOD: EMD variables were compared with encounter data from the nationally representative BEACH program using χ2 tests and robust 95% confidence intervals to test their validity (measure what they reportedly measure). The variables focused on for this study were patient age, sex, smoking status and medications prescribed at the visit. RESULTS: The EMD sample from six general practices in the Illawarra region of New South Wales, Australia, yielded data on 196,515 patient encounters. Details of 90,553 encounters were recorded in the 2013 BEACH dataset from 924 general practitioners. No significant differences in patient age ( p = 0.36) or sex ( p = 0.39) were found. EMD had a lower rate of current smokers and higher average scripts per visit, but similar prescribing distribution patterns. CONCLUSION: Validating EMD variables offers avenues for improving primary care delivery and measuring outcomes of care to inform clinical practice and health policy.


Assuntos
Registros Eletrônicos de Saúde , Pesquisa sobre Serviços de Saúde , Atenção Primária à Saúde , Adulto , Feminino , Humanos , Masculino , New South Wales
9.
Aust Fam Physician ; 45(11): 734-739, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27806453

RESUMO

BACKGROUND: Chronic heart failure is a common clinical syndrome associated with high healthcare system use. OBJECTIVE: The aim of this study was to explore the management of chronic heart failure in Australian general practice. METHODS: Data from the Bettering the Evaluation and Care of Health program were used to determine the prevalence of chronic heart failure, use of natriuretic peptide testing, prescribing patterns, hospitalisation rates and referrals to community-based heart failure management programs in three study periods between 2010 and 2015. RESULTS: Data on 8989 patients from 308 general practitioners were analysed. Of these patients, 324 had chronic heart failure (prevalence 3.6%; 95% confidence interval [CI]: 3.1-4.2), 44% (95% CI: 34.5-53.6) of whom had been hospitalised for the condition. The mean number of prescribed heart failure medication agents was 2.26 (95% CI: 2.13-2.39) per patient. Discharge under community heart failure programs was not routine. DISCUSSION: Chronic heart failure is a significant burden in general practice. Strategies to optimise management and avoid hospitalisation, where possible, are needed.


Assuntos
Gerenciamento Clínico , Medicina Geral/métodos , Insuficiência Cardíaca/terapia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Biomarcadores/sangue , Fármacos Cardiovasculares/uso terapêutico , Doença Crônica/tratamento farmacológico , Doença Crônica/mortalidade , Feminino , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeos Natriuréticos/análise , Peptídeos Natriuréticos/sangue , Prevalência
10.
Aust Fam Physician ; 45(6): 363-5, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27622222

RESUMO

Otitis media (OM) is one of the most common infections in children. The cause can be viral, but is most often bacterial. It remains one of the most common reasons for antibiotic prescribing for children. Many episodes of acute OM are self-limiting and resolve without treatment, but antibiotics are often prescribed because these infections can develop into serious, sometimes life-threatening complications.


Assuntos
Antibacterianos/uso terapêutico , Otite Média/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Austrália , Criança , Pré-Escolar , Medicina Geral/estatística & dados numéricos , Humanos , Lactente
13.
Med J Aust ; 205(2): 79-83, 2016 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-27456449

RESUMO

OBJECTIVES: To quantify the time that general practitioners spend on patient care that is not claimable from Medicare (non-billable) and the monetary value of this work were it claimable, and to identify variables independently associated with non-billable time. DESIGN: Prospective, cross-sectional survey, April 2012 - March 2014. SETTING: Australian general practice; a substudy of the national Bettering the Evaluation and Care of Health (BEACH) program. PARTICIPANTS: 1935 randomly sampled GPs (77.4% participation rate) from across Australia provided filled questionnaires on 66 458 patient encounters. MAIN OUTCOME MEASURES: Non-billable time spent on patient care since patient's previous consultation; duration of and reasons for non-billable time; estimate of its monetary value were it claimable from Medicare; variables associated with non-billable time. RESULTS: 69.5% of GPs reported non-billable care outside patient visits; 8019 patient encounters (12.1%) were associated with an occasion of non-billable time. Mean time spent per occasion was 10.1 min (range, 1-240 min). Reasons for non-billable time included arranging tests and referrals, consulting specialists or allied health professionals, medication renewals, and advice and education, and encompassed all International Classification of Primary Care Version 2 chapters. The notional average annual value per GP of this work was $10 525.95 (level A rebate) to $23 008.05 (level B). Non-billable time was independently associated with female GPs, younger GPs (under 55 years), female patients, patients aged 65 years or more, and one or more chronic problems being managed at the recorded encounter. CONCLUSION: Most GPs spend a significant amount of unpaid time on patient care between consultations, an inherent problem of the fee-for-service system. This work should inform discussions of future funding models.


Assuntos
Medicina Geral/economia , Programas Nacionais de Saúde/economia , Encaminhamento e Consulta/economia , Mecanismo de Reembolso/economia , Adulto , Fatores Etários , Idoso , Austrália , Estudos Transversais , Assistência à Saúde/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais
14.
Aust N Z J Public Health ; 40(3): 239-44, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27027989

RESUMO

OBJECTIVE: To measure prevalence of multimorbidity and complex multimorbidity in the Australian population from a nationally representative prospective study and to identify the most prevalent patterns of chronic conditions and body systems affected. METHODS: A sub-study of the nationally representative BEACH program, using a random sample of 8,707 patients at encounters with 290 general practitioners. All diagnosed chronic conditions were recorded for each patient. Multimorbidity was defined as co-occurrence of 2+ chronic conditions, while complex multimorbidity was defined as 3+ body systems each affected by at least one chronic condition. RESULTS: We estimated: 47.4% of patients at GP encounters and one-third (32.6%) of the population had multimorbidity; and 27.4% of patients at GP encounters and 17.0% of the Australian population had complex multimorbidity. The most prevalent combination pattern of three conditions was hypertension+hyperlipidaemia+ osteoarthritis (5.5% of patient at encounters and 3.3% of the population). Most prevalent combination of three body systems affected was circulatory+musculoskeletal+endocrine / nutritional/metabolic systems (11.1% of patients at encounters and 7.0% of the population). CONCLUSIONS AND IMPLICATIONS: A significant proportion of Australians have not only multimorbidity, but complex multimorbidity. To meet the challenge posed by complex multimorbidity, the single disease focus of our healthcare system needs to be re-evaluated.


Assuntos
Doença Crônica/epidemiologia , Austrália/epidemiologia , Comorbidade , Depressão/epidemiologia , Medicina Geral , Humanos , Hipertensão/epidemiologia , Prevalência , Estudos Prospectivos
15.
Aust Fam Physician ; 44(6): 349-51, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26209981

RESUMO

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.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Medicina Geral , Adolescente , Corticosteroides/uso terapêutico , Asma/epidemiologia , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência
16.
Aust Fam Physician ; 44(1-2): 14-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25688953

RESUMO

Over the decade to June 2014, the number of annual short-term resident departures from Australia more than doubled, from 3.9 million to 8.9 million per year. A large number of these journeys involved destinations with known risk of exposure to vector-borne and enteric diseases. Many of these disease risks are preventable if travellers seek advice about the areas they choose to visit, and are vaccinated in the appropriate time frame before their departure. Vaccination is an essential component of national control of travel-associated infectious diseases. General practitioners (GPs) are well-placed to inform patients about potential disease risks in their intended travel regions and to vaccinate patients before their departure.


Assuntos
Gestão de Riscos/normas , Viagem/tendências , Vacinação/tendências , Austrália , Doenças Transmissíveis , Humanos , Percepção , Gestão de Riscos/tendências
17.
Health Inf Manag ; 44(3): 4-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26744758

RESUMO

Health information management professionals have a broad range of skills that are invaluable to the health sector. The advent of the electronic health record has provided the opportunity to aggregate patient data to answer clinical and policy questions in a systematic, timely and reproducible way. The possibility of linking datasets provides greater opportunities for answering clinical and policy questions, and Health Information Managers (HIMs) have the best skill set to inform about data quality, coding and classification, privacy, security, and medico-legal implications involved in the ethical handling of such datasets. HIMs have access to a wealth of data that could improve patient care and reduce unnecessary service utilisation, and that could be used to answer many research questions. Undertaking and publishing research is an excellent avenue for HIMs to promote and strengthen their profession.


Assuntos
Gerentes de Casos , Gestão da Informação em Saúde , Registros Eletrônicos de Saúde , Humanos , Assistência ao Paciente , Melhoria de Qualidade
18.
Aust Fam Physician ; 43(8): 507, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25114982

RESUMO

There is a paucity of Australian state-based data on the incidence of non-melanoma skin cancer (NMSC). Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin are not notifiable diseases and are not collected by the state and territory cancer registries. In a 2002 survey, the Australian age-standardised incidence per 100,000 persons for NMSC was 1170 (BCC 884, SCC 387), with a higher incidence in the northern latitudes.


Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Austrália/epidemiologia , Humanos
19.
BMJ Open ; 4(7): e004694, 2014 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-25015470

RESUMO

OBJECTIVES: Prevalence estimates of multimorbidity vary widely due to inconsistent definitions and measurement methods. This study examines the independent effects on prevalence estimates of how 'disease entity' is defined-as a single chronic condition or chapters/domains in the International Classification of Primary Care (V.2; ICPC-2), International Classification of Disease (10th revision; ICD-10) or the Cumulative Illness Rating Scale (CIRS), the number of disease entities required for multimorbidity, and the number of chronic conditions studied. DESIGN: National prospective cross-sectional study. SETTING: Australian general practice. PARTICIPANTS: 8707 random consenting deidentified patient encounters with 290 randomly selected general practitioners. MAIN OUTCOME MEASURES: Prevalence estimates of multimorbidity using different definitions. RESULTS: Data classified to ICPC-2 chapters, ICD-10 chapters or CIRS domains produce similar multimorbidity prevalence estimates. When multimorbidity was defined as two or more (2+) disease entities: counting individual chronic conditions and groups of chronic conditions produced similar estimates; the 12 most prevalent chronic conditions identified about 80% of those identified using all chronic conditions. When multimorbidity was defined as 3+ disease entities: counting individual chronic conditions produced significantly higher estimates than counting groups of chronic conditions; the 12 most prevalent chronic conditions identified only two-thirds of patients identified using all chronic conditions. CONCLUSIONS: Multimorbidity defined as 2+ disease entities can be measured using different definitions of disease entity with as few as 12 prevalent chronic conditions, but lacks specificity to be useful, especially in older people. Multimorbidity, defined as 3+, requires more measurement conformity and inclusion of all chronic conditions, but provides greater specificity than the 2+ definition. The proposed concept of "complex multimorbidity", the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person without defining an index chronic condition, may be useful in identifying high-need individuals.


Assuntos
Doença Crônica/epidemiologia , Medicina Geral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Comorbidade/tendências , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Estudos Retrospectivos
20.
Aust Fam Physician ; 43(3): 93, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24600667

RESUMO

In 2012, about 50,000 Australians had a stroke (cerebrovascular accident (CVA)). The risk of stroke is associated with increased age, previous stroke or transient ischaemic attack, hypertension, smoking, diabetes mellitus (DM), hypercholesterolaemia and atrial fibrillation/flutter (AF). Australian general practice data from the national BEACH program between April 2000 and March 2013 inclusive (1,276,200 GP-patient encounters) were analysed to determine the patient characteristics, associated conditions and management options at those encounters where a CVA was recorded, and detect changes in the annual management rates of CVA, AF, lipid disorders (LD), DM and hypertension.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso , Fibrilação Atrial/complicações , Austrália/epidemiologia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipertensão/complicações , Masculino , Recidiva , Fatores de Risco , Fumar/efeitos adversos , Acidente Vascular Cerebral/complicações
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