Characteristics of longer consultations in Australian general practice

Abstract

ObjectiveTo assess the association between general practitioner (GP) billing for “longer” consultations, patient factors linked with health care need, and other consultation characteristics. DesignRetrospective analysis of data from Medicare (1984‐1992), Australian Morbidity and Treatment Survey (1990‐1991) and Australian Capital Territory Record Linkage Study (1988‐1992). SettingAustralian general practice, 1984 (introduction of Medicare) to 1992. Main outcome measuresConsultations billed as longer (< 20 or >25 minutes) compared with standard; type of billing (bulk or private); patient health care need (defined as health and sociodemographic factors linked to worse health outcomes); consultation continuity, type of care given and number of problems managed. ResultsLonger billed consultations Increased between 1984 and 1992, from 2.8% to 6.7% of all standard and longer consultations. Longer consultations were more likely to be bulk‐billed than privately billed (odds ratio [OR], 1.74). They were more likely than standard consultations to deal with psychological diagnoses (OR, 2.06; 95% confidence Interval [95% Cl], 1.83‐2.32) or multiple problems (OR for four versus one diagnosis, 5.18; 95% Cl, 4.31‐6.22) and to Involve patients aged under 50 years, new to the practice or with new problems, but not chronic disease. In the ACT, those billed for longer consultations were more commonly tertiary educated (OR, 1.99; 95% Cl, 1.35‐2.94), bulk‐billed (OR, 2.75; 95% Cl, 2.51‐3.10), aged 40‐49 years and non‐obese. ConclusionLonger billed consultations were not associated with greater patient need, other than psychosocial need, but with bulk billing and patient socioeconomic advantage. However, evaluation was complicated by the effects of continuity of care and number of problems managed In the consultation.

Consultation length and chronic illness care in general practice: a qualitative study

“…This was more likely to occur in consultations of 20 or more minutes' duration (level C or above in the current descriptors or band 4 upwards in the proposed MSRTF descriptors). The ratio of standard to longer consultations in our study contrasts with national data (ratio of consultations with patients with a chronic disease diagnosis billed as standard [6-20 minutes] to those billed as longer [;;;.20 minutes] was closer to 16:1 in 1990-1991, 3 and not significantly different from the ratio for the whole population").…”

“…Consequently, there was a greater proportion of longer consultations than national data would predict. 3…”

Access and equity in the provision of general practitioner services for women in Australia

“…22 The HIC data showed that young women tended to see lessqualified practitioners, to see a greater number of different practitioners and to have fewer long consultations than older women. These findings are consistent with other Australian studies that have examined length of consultation 23 and use of multiple providers 24 in smaller samples. Lack of continuity of care among young women may reflect dissatisfaction with providers 22,24 or may be the result of the greater geographical mobility of these women.…”

Health services research using linked records: who consents and what is the gain?

“…A comparison of self-report and HIC records showed that record linkage provided accurate and economical measurement of health service use. 4 Several studies have been based on the linked records for these 521 persons concluding that a prospective longitudinal study was needed to explore the reasons why people see multiple general practitioners (GPs), 5 to determine whether longer consultations are accessed by those who need them most 6 and to investigate the relationship between patient need and health care supply and demand. 7 They also concluded that the population consent rates to such linkage remained to be established.…”