Lisa Valenti

General practice management of overweight and obesity in children and adolescents in Australia.

Background:Childhood obesity is rapidly increasing in prevalence worldwide, but healthcare capacity to address this problem seems limited. Objective:The purpose of this study was to describe the prevalence and rate of management of childhood overweight and obesity in Australian general practice. Subjects:A cross-sectional study consisting of 3978 general practitioners (GPs), randomly selected using Medicare Australia claims, who recorded 42,515 encounters with children age 2–17 including 12,925 sub-sampled encounters with self or carer-reported height and weight collected. Measures:Prevalence of overweight and obesity, rate of management of overweight and obesity, content of encounters in overweight and nonoverweight children, content of encounters in those managed for overweight and obesity, and management to prevalence ratio. Results:A total of 29.6% of sub-sampled children were classified as overweight (18.3%) or obese (11.4%). GPs managed overweight and obesity during 215 encounters, or once per 200 encounters with children age 2–17 and once per 58 encounters with overweight or obese children. The content of encounters in overweight and non-overweight children did not differ. Children who were managed for overweight or obesity presented with these conditions as reasons for the encounter significantly more often [66.5 (95% confidence interval (CI): 59.7–73.3) vs. 1.2 (95% CI: 1.0–1.3)] and were managed for more problems, particularly depression [4.2 (95% CI: 1.5–6.9) vs. 0.8 (95% CI: 0.7–0.9)], than average per 100 encounters. Consultations for overweight or obesity were significantly longer than average [16.7 (95% CI: 14.7–18.7) vs. 12.4 (95% CI: 12.2–12.5) minutes]. Conclusions:Overweight and obesity are prevalent in children presenting to Australian general practice but GPs do not use most of the available opportunities to manage this problem.

Sevenfold rise in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000-2011

Objective: To better understand the role that diagnostic test‐ordering behaviour of general practitioners has on current pertussis epidemiology in Australia.

The relationship between self-reported alcohol intake and the morbidities managed by GPs in Australia

BackgroundOne in five Australians consume alcohol at risky or harmful levels. Most (85%) attend a general practitioner at least once a year, giving opportunity for detecting and providing brief interventions for reducing alcohol-related harm. Historically, detection rates of problem drinking have been low in general practice, producing lower prevalence estimates of heavy drinking than expected from population surveys.MethodThe BEACH program collects data from 100 consecutive patient consultations with 1000 GPs annually. For 40 consecutive encounters, GPs ask adult patients three questions on alcohol consumption (AUDIT-C). This paper reports the problems managed and treatments provided at encounters with heavy and non-heavy drinkers, grouped by their response to the 3rd question, and compares the two groups before and after standardisation for age and sex. Heavy drinking was defined as having 6 or more standard drinks at least once a week or more often.ResultsHeavy drinking was reported by 7.3% patients overall; more prevalent among men (13.8%) than women (3.9%); and among Indigenous patients (18.5%). Prevalence was highest in young adults (18–24 years)(12.7%) and decreased with age. Patients from a non-English speaking background were less likely to be heavy drinkers. Heavy drinkers had more problems managed at encounters, more chronic problems, physical injuries and psychological problems (particularly depression) managed than non-heavy drinkers. They were less likely to have respiratory complaints, ischaemic heart disease or diabetes managed.ConclusionHeavy drinkers are more likely than non- or light drinkers to see their GP for management of chronic problems, psychological problems and physical injuries. However, the wide range of morbidity managed in heavy drinkers means that relying on clinical impression alone to detect this group will not suffice and should be augmented with routine screening. Given the pressures of general practice, finding efficient methods of screening for alcohol problems remains a priority.

Changes in longer consultations for children in general practice

To determine if the duration of general practitioner (GP) consultations, or the proportional distribution of item numbers associated with longer consultations, with children has changed in association with the demographic changes in Australia.

Drugs causing adverse events in patients aged 45 or older: a randomised survey of Australian general practice patients

Objective To determine prevalence of adverse drug events (ADEs) in patients aged 45 years or older presenting to Australian general practitioners (GPs) and identify drug groups related to ADEs, their severity and manifestation. Design Substudy of the Bettering the Evaluation and Care of Health continuous survey of Australian GP clinical activity in which randomly selected GPs collected survey data from patients. Data are reported with 95% CIs. Setting General practice in Australia. Main outcome measures Prevalence in the preceding 6 months, type, implicated drugs, severity (including hospitalisation) and manifestation of ADEs. Participants From three survey samples, January–October 2007, and two samples, January–March 2010, responses were received from 482 GPs about 7561 patients aged 45 years or older. Results Of a final sample of 7518 patients (after duplicate patients removed), 871 (11.6%) reported ADEs in the previous 6 months. The type of ADE was recognised side effect (75.8%, 95% CI 72.0 to 79.7), drug sensitivity (9.9%, 95% CI 7.2 to 12.7) and drug allergy (7.4%, 95% CI 4.7 to 10.1). Drug interaction (1.0%, 95% CI 0.1 to 1.8), overdose (0.8%, 95% CI 0.0 to 1.5) and contraindications (0.2%, 95% CI 0.0 to 0.6) were very infrequent. A severity rating was provided for 846 patients. Almost half (45.9%, 95% CI 42.0 to 49.7) were rated as ‘mild’ events, 42.2% (95% CI 38.8 to 45.6) ‘moderate’, 11.8% (95% CI 9.5 to 14.1) severe and 5.4% (95% CI 3.8 to 7.0) had been hospitalised as a result of the most recent ADE. Thirteen commonly prescribed drug groups accounted for 58% of all ADEs, opioids being the group most often implicated. Conclusion ADEs in patients aged 45 or older are frequent and are associated with significant morbidity. Most of ADEs result from commonly prescribed drugs at therapeutic dosage. The list of causative agents bears little relationship to published lists of ‘inappropriate medications’.

Estimating non-billable time in Australian general practice

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.

Gp-initiated pathology testing: data from the beach program

The BEACH study is a continuous national study of general practice activity. Each year approximately 1000 randomly sampled GPs provide data about 100 000 encounters. It contains data about pathology ordered at these encounters. In 2009-2010, GPs ordered 45.0 pathology tests/batteries per 100 encounters or 29.3 per 100 problems. At least one pathology test order was recorded at 17.7% of encounters (for 13.2% of problems managed), chemistry tests accounting for more than half of all pathology tests. Since 2000, rises in the number of tested problems and the number of problems managed at GP encounters contributed to overall increases in the proportion of encounters involving a pathology test, and the number of tests ordered by GPs. BEACH pathology data have been used to investigate: • the problems responsible for the highest volume and growth of testing in primary care and how GPs’ testing behaviour in the management of these problems has changed; • the extent to which GP-ordered pathology for type 2 diabetes, hypertension, lipid disorders, weakness/tiredness, ‘health checks’ and overweight/obesity aligned with testing recommended in inter/national guidance; • expected volume of GP-ordered testing in 2020 using patient age-sex-specific test rates, extrapolated using GP-attendance rates and national population projections.