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General Practice Activity in Australia 2015-16 General practice activity in Australia 2015–16 Bettering the Evaluation and Care of Health Helena Britt, Graeme C Miller, Joan Henderson, Clare Bayram, Christopher Harrison, Lisa Valenti, Ying Pan, Janice Charles, Allan J Pollack, Carmen Wong, Julie Gordon Family Medicine Research Centre Sydney School of Public Health The University of Sydney GENERAL PRACTICE SERIES NUMBER 40 September 2016 Published 2016 by Sydney University Press SYDNEY UNIVERSITY PRESS The University of Sydney Library sydney.edu.au/sup © Sydney University Press 2016 Reproduction and communication for other purposes Except as permitted under the Act, no part of this edition may be reproduced, stored in a retrieval system, or communicated in any form or by any means without prior written permission. All requests for reproduction or communication should be made to Sydney University Press at the address below: Sydney University Press Fisher Library F03 University of Sydney NSW 2006 AUSTRALIA Email: [email protected] Any enquiries about or comments on this publication should be directed to: Christopher Harrison, Menzies Centre for Health Policy Sydney School of Public Health, University of Sydney Email: [email protected] or [email protected] Phone: 0411 197 938 This publication is part of the General practice series based on results from the BEACH program conducted by the Family Medicine Research Centre (FMRC). A complete list of the Centre’s publications is available from the FMRC’s website <sydney.edu.au/medicine/fmrc/>. ISSN 1442-3022 ISBN 9781743325131 (print) ISBN 9781743325148 (online) Suggested citation Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L, Pan Y, Charles J, Pollack AJ, Wong C, Gordon J. General practice activity in Australia 2015–16. General practice series no. 40. Sydney: Sydney University Press, 2016. Available at <purl.library.usyd.edu.au/sup/9781743325131> Keywords Australia, delivery of health care/statistics and numerical data, family practice/statistics and numerical data, general practice, health services utilization, healthcare surveys/methods. Companion publication Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C, Pan Y, Charles J, Pollack AJ, Chambers T, Gordon J, Wong C. A decade of Australian general practice activity 2006–07 to 2015–16. General practice series no. 41. Sydney: Sydney University Press, 2016 Available at <purl.library.usyd.edu.au/sup/9781743325155> Cover design by Miguel Yamin Printed in Australia ii Preface This report and its companion volume A decade of Australian general practice activity 2006–07 to 2015–16 are the last annual reports from the Bettering the Evaluation and Care of Health (BEACH) program. The BEACH program was born in the late 1990s out of the growing perceived need for the development and collection of standardised data on primary medical care encounters in Australia. While sections of the Commonwealth Department of Health (DoH) clearly recognised the need for ongoing up-to-date information about the clinical activities of GPs, the DoH was not willing or able to fund a continuous program in full. However, it did agree to consider a contribution to its costs. After about 20 years of methods development, largely funded by NHMRC grants, in 1997 the Family Medicine Research Unit (FMRU) in the Department of General Practice at the University of Sydney was ready to launch a continuing data collection program, and approached the Australian Institute of Health and Welfare (AIHW) as a collaborator. This led to the establishment of the General Practice Statistics and Classification Unit (GPSCU), a collaborating unit of the AIHW located within the FMRU at the University of Sydney. We sought funding from the pharmaceutical industry, and approached a range of other Government Departments and instrumentalities. Sufficient research contracts were established for the GPSCU to start the BEACH program on 1st April 1998 and data collection continued uninterrupted until 30 March 2016. The FMRU became a recognised Centre (FMRC) of the University in 1999. The BEACH program built on the lessons learned in the Australian Morbidity and Treatment Survey and Country Metropolitan Study conducted by the FMRU in 1990 and on further methods using that data as the basis for modelling the required sample size to represent Australia, developing more specific coding systems for pharmaceutical and clinical treatments, and new analytical tools to deal with the complex relationships between patients, GPs, patient’s reasons for encounter, problems managed, and management actions provided by GPs in management of each individual problem. In BEACH we also added a new concept of patient based sub-studies (called Supplementary Analysis of Nominated Data (SAND) studies) conducted in conjunction with the collection of GP–patient encounter data. BEACH was designed as a continuous ongoing program rather than the ‘snapshot’ approach used in previous Australian studies and virtually all overseas GP data collection programs. Over 18 years BEACH has provided an invaluable source of timely data to describe general practice activity and inform improvements in primary health care service provision. BEACH and the associated SAND studies have also provided a rich source of data for analysis by the BEACH research team, frequently in collaboration with other stakeholders and academics across Australia. The FMRC research outputs include: • 41 BEACH books, 7 other books and contributions to a further 10 books • about 178 refereed articles in recognised journals (with 3 in press, 5 under review and more about to be submitted), • 140 unrefereed articles in recognised journals • 71 papers in other journals and publications (e.g. ‘Bytes from BEACH’ FMRC web site, articles in The Conversation, etc.) • 16 theses and treatises (incl. 5 PhDs) • 223 SAND sub-studies on a wide range of topics (all published as Abstracts) • hundreds of conference presentations • over 1000 bespoke reports for stakeholders, researchers, governments and industry. iii Funding for BEACH has never been certain throughout the 18 years of the program and the team have lived with annual renewable appointment (dependent on funding availability) throughout. BEACH and the FMRC have now closed due to lack of direct support from the Australian Government and dwindling support from a health industry plagued by a lack of research resources. The BEACH resource is unique in its ability to inform research, policy and practice and it is of deep concern that there is currently nothing to replace it. Its demise will leave a large gap in our understanding of the care provided by GPs to the community. The FMRC was not the only casualty of the withdrawal of government support – the Australian Primary Health Care Research Institute and its associated research centres have closed and the Primary Health Care Research and Information Service is on borrowed time. This brings to an end 25 years of high quality general practice research, funding for which was initiated by the recommendations of the Senate Select Committee on vocational registration in 1989 and long supported by the Commonwealth Government. In this new era, download of data collected by GPs in patient’s electronic health records (EHRs) is the flavour of the month. Basic methodological processes developed by the BEACH team – such as standardised coding and classification, and mandatory recorded relationships between problem management and the management actions taken – are being ignored. ‘Big data’ is seen as the solution – people seem to believe that sheer size overrides the need for data quality. Based on our experience, big data will not be better than ‘small data’ until standards are applied to the core information in the EHRs, including standardised data elements and data definitions, specified data element relationships (e.g. management actions linked to a problem managed), minimum data sets for ‘patient’ and ‘encounter’, standardised classifications and terminologies and a standard definition of what constitutes ‘chronic’.1 Currently, NPS MedicineWise, almost all the Primary Health Networks, multiple university departments, state governments and commercial consulting organisations all collect and analyse data in their own way, and so none of the results can be comparable with the other. This work is being done at massive cost, and yet we have yet to see published reports of findings. We can only conclude that in the foreseeable future, without BEACH there will be very little reliable, independent national information publicly available about GP clinical activity. The care of accumulated BEACH databases has been transferred within the University of Sydney, to the Menzies Centre for Health Policy, and will continue to be a rich resource of data for research into general practice. Researchers, government, and industry are encouraged to visit the FMRC website for further contact details to request reports from the BEACH data. The website will remain a source of information about a wide range of topics related to general practice in Australia. Helena Britt BA, PhD Graeme Miller MB BS, FRACGP, PhD (Then) Director, Family Medicine Research Centre (Then) A/Professor & Medical Director Professor of Primary Care Research Honorary Associate Professor School of Public Health School of Public Health University of Sydney University of Sydney 1. Gordon J, Miller G, Britt H. Reality check – reliable national data from general practice EHRs. Deeble Institute Issues Brief No 18. Canberra:
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