Estimating non-billable time in Australian general practice

The impact of a multi-hospital network on the inequality in odds of receiving resection or ablation for synchronous colorectal liver metastases

BACKGROUND

This study investigates whether inequalities in the utilization of resection and/or ablation for synchronous colorectal liver metastases (SCLM) between patients diagnosed in expert and non-expert hospitals changed since a multi-hospital network started.

MATERIALS AND METHODS

Patients diagnosed with SCLM between 2009 and 2020 were included. The likelihood of receiving ablation and/or resection was analyzed in the prenetwork (2009-2012), startup (2013-2016), and matured-network (2017-2020) periods.

RESULTS

Nationwide, 13.981patients were diagnosed between 2009 and 2020, of whom 1.624 were diagnosed in the network. Of patients diagnosed in the network's expert hospitals, 36.7% received ablation and/or resection versus 28.3% in nonexpert hospitals (p < 0.01). The odds ratio (OR) of receiving ablation and/or resection for patients diagnosed in expert versus nonexpert hospitals increased from 1.38 (p = 0.581, pre-network), to 1.66 (p = 0.108, startup), to 2.48 (p = 0.090, matured-network). Nationwide, the same trend occurred (respectively OR 1.41, p = 0.011; OR 2.23, p < 0.001; OR 3.20, p < 0.001).

CONCLUSIONS

Patients diagnosed in expert hospitals were more likely to receive ablation and/or resection for SCLM than patients diagnosed in non-expert hospitals. This difference increased over time despite the startup of a multi-hospital network. Establishing a multi-hospital network did not have an effect on reducing the existing unequal odds of receiving specialized treatment.

SYNOPSIS

Specialized oncology treatments are increasingly provided through multi-hospital networks. However, scant empirical evidence on the effectiveness of these networks exists. This study analyzes whether a regional multi-hospital network was able to improve equal access to specialized oncology treatments.

Understanding the factors that influence communication about COVID-19 vaccines with patients: Perspectives of Australian immunisation providers

Background

COVID-19 immunisation providers have been at the forefront of the pandemic, and their ability to communicate effectively with patients is key to encouraging COVID-19 vaccine acceptance and uptake. This study explored providers' perspectives on the factors influencing communication with patients about COVID-19 vaccines.

Methods

We used an explanatory-sequential mixed-methods approach to conduct the study between December 2021 and March 2022. Phase I involved a cross-sectional survey with immunisation providers in New South Wales (n = 341; 189 general practitioners, 118 nurses and 34 pharmacists), followed by Phase II: semi-structured, in-depth qualitative interviews (n = 19; 10 nurses, 9 pharmacists). We generated descriptive results for the survey. We analysed the qualitative data thematically using an inductive approach.

Results

Almost half of survey participants reported communicating often with people who were hesitant about COVID-19 vaccines (49 %; 166/341), however, 21 % (71/341) reported inadequate time to address concerns during consultations. Interview participants reported communication challenges, including time constraints, difficulties addressing and eliciting patient concerns, and keeping up to date with changing information. Conversely, interview participants reported that easy access to government information resources, time to learn about COVID-19 vaccines proactively, knowing about and being able to use tailored strategies to support Aboriginal and Torres Strait Islander and CALD patients were helpful when communicating with patients.

Conclusions

Immunisation providers play an important role in patient vaccine acceptance and uptake. Our findings indicate that whilst providers were largely confident in their interactions with patients, further communication support would strengthen providers' skills in communicating with patients who have questions and concerns about COVID-19 vaccines.

General Practice Statistics in Australia: Pushing a Round Peg into a Square Hole

In Australia, general practice forms a core part of the health system, with general practitioners (GPs) having a gatekeeper role for patients to receive care from other health services. GPs manage the care of patients across their lifespan and have roles in preventive health care, chronic condition management, multimorbidity and population health. Most people in Australia see a GP once in any given year. Draft reforms have been released by the Australian Government that may change the model of general practice currently implemented in Australia. In order to quantify the impact and effectiveness of any implemented reforms in the future, reliable and valid data about general practice clinical activity over time, will be needed. In this context, this commentary outlines the historical and current approaches used to obtain general practice statistics in Australia and highlights the benefits and limitations of these approaches. The role of data generated from GP electronic health record extractions is discussed. A methodology to generate high quality statistics from Australian general practice in the future is presented.

Model of nutritional care in older adults: improving the identification and management of malnutrition using the Mini Nutritional Assessment-Short Form (MNA®-SF) in general practice

Despite clinical guidelines recommending routine nutrition screening, malnutrition in community-living older adults remains under-recognised. This study evaluated the uptake of a model of nutritional care in older adults designed to improve the identification and management of malnutrition. A pragmatic quasi-experimental study was conducted in eight general practices in regional New South Wales between January 2017 and June 2018. Study participants comprised GPs and practice nurses who participated in a training event on the identification and management of malnutrition and patients (aged >65 years) attending the practices recruited to the study. Nutritional screening was conducted using the Mini Nutritional Assessment-Short Form. The specific objectives of the study were to: (1) evaluate the effects of the intervention on knowledge, attitudes and practices of staff related to malnutrition screening using questionnaires and in-depth interviews; and (2) identify patients' experiences and outcome measures following malnutrition screening through self-completed surveys. Across the eight practices, 11 healthcare professionals completed in-depth interviews. Post-training knowledge surveys (n = 25) identified that knowledge increased in 96% of staff (P < 0.001). Fifty-five older adults who were screened (two malnourished, 10 'at risk of malnutrition') reported an increased awareness of risk factors for malnutrition. This study provides proof-of-concept that a model of care that includes routine malnutrition screening and accompanying pathways for management is acceptable to general practice staff and has promising effects on patient outcomes. However, the low number of patients screened suggests that additional processes are required to improve feasibility (e.g. incorporation into Medicare-funded nurse-led consultations such as the 75+ Health Assessment).

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.

What matters to people with chronic conditions when accessing care in Australian general practice? A qualitative study of patient, carer, and provider perspectives

BACKGROUND

Research underpinning the patient experience of people with chronic conditions in Australian general practice is not well developed. We aimed to ascertain the perspectives of key stakeholders on aspects of patient experience, more specifically with regards to accessing general practice in Australia.

METHODS

Using a qualitative design, semi-structured interviews were conducted by telephone and face-to-face with people living with one or more chronic conditions, informal carers, and primary care providers between October 2016 and October 2017. Participants were recruited and selected from three demographically representative primary health networks across Sydney, Australia. Interview transcripts and researcher's reflective fieldnotes were coded and analyzed for key themes of access. Analysis and interpretation of data were guided by Levesque's model of access, a conceptual framework to evaluate access broadly and from corresponding patient- and provider-side dimensions.

RESULTS

A total of 40 interviews were included in the analysis. Most participants had attended their general practices for 10 years or more and had regular primary care providers. People with chronic conditions reported access barriers predominantly in their ability to reach services, which were related to illness-related disabilities (limited mobility, chronic pain, fatigue, frailty) and limitations in the availability and accommodation of health services to address patient preferences (unavailability of after-hours services, lack of alternative modes of service delivery). While cost was not a major barrier, we found a lack of clarity in the factors that determined providers' decisions to waive or reduce costs for some patients and not others.

CONCLUSIONS

People managing chronic conditions with a long-term primary care provider experienced access barriers in general practice, particularly in their ability to physically reach care and to do so on a timely basis. This study has important policy and practice implications, as it highlights patients' experiences of accessing care and possible areas for improvement to appropriately respond to these experiences. Themes identified may be useful in the design of a patient experience survey tool specific to this population. While it incorporates perspectives from patients, carers and providers, this study could be further strengthened by including perspectives from culturally and linguistically underrepresented patient groups and more carers.