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Invest in general practice to ensure health of older Australians, say experts

4 November 2015
The federal government should invest in more general practitioner-based primary care to ensure quality care of older Australians, two new reports recommend.

Published today, the two reports by the BEACH research program of the University of Sydney’s Family Medicine Research Centre reveal changing patterns in GP-delivered services as general practice rises to the challenge of complex chronic disease management, particularly in older patients.

“The federal government wants to make sure ‘Medicare is sustainable,’ ” says Associate Professor Helena Britt, lead investigator of the two reports. “One of their main concerns is that our population is ageing, and that this will put increasing strain on the health system and the health care budget.”

In 2014-15 people aged 65 years and older used twice as many health resources as the average for the population in terms of GP encounters, GP clinical time, problems managed, medications prescribed or provided, referrals, imaging and pathology tests orders.

An analysis of changing patterns in healthcare use over the last 15 years showed that service use by these older people grew far more than their 18 per cent growth as a proportion of the population. Over the past 15 years (2000–01 to 2014–15) their service use grew from:

  • 22.8% to 27.8% (a 22% relative increase) of all GP-patient encounters
  • 23.9% to 28.7% (a 20% relative increase) of all face-to-face GP clinical time
  • 26.9% to 35.0% (a 30% relative increase) of all problems managed in general practice
  • 28.2% to 35.8% (a 27% relative increase) of all medications recorded
  • 24.9% to 30.8% (a 24% relative increase) of all imaging and pathology tests ordered
  • 24.2% to 32.2% (a 33% relative increase) of all referrals made.

“This growth in service use probably results from earlier diagnosis of chronic diseases. So, as we get older and live longer, we therefore have an increasing number of diagnosed chronic conditions needing to be managed,” Dr Britt says.

The study showed that among people aged 65 plus:

  • 90 per cent have at least one diagnosed chronic conditions, and 1 in 4 have five or more
  • one in three live with chronic pain
  • are taking 5.6 medications on average
  • one in ten has experienced an adverse drug event in the past six months
  • see a GP about ten times per year on average.

“The good news is that while older Australians use more health resources than average for the community, our health bill is similar to comparable countries such as the UK, Canada and New Zealand) and we enjoy one of the world’s longest life expectancies,” says A/Professor Britt.

“Further, we spend about half the amount as the United States on health per head of population yet our life expectancy is four years longer than theirs – 83 years compared to 79 years in the US.

“One of the biggest differences between healthcare in Australia and the US is that primary care is the core of our system, with GPs acting as ‘gatekeepers’ to more expensive care. If people are well managed in general practice there’s less need for private specialists and hospital admissions.

“Our reports reveal that nearly all older patients – 99 per cent –have a general practice they usually visit. This means GPs in these practices can access a shared patient health record that aids continuity of care.

“It also lowers the risk of test duplication and fragmentation of services. If general practice wasn’t at the core of our health care system, it’s likely the overall cost of our health care would be far higher.”

Dan Gaffney

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