Characteristics of patients who access zero, one or multiple general practices and reasons for their choices: a study in regional Australia

Abstract

Background Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none. Methods A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey. Results Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97–0.99), residence in the regional centre aOR 2.90(2.22–3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22–2.21) and no out of pocket costs aOR 1.36(1.04–1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p < 0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p = 0.006) than single practice attendees. Conclusions Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.

The influence of care continuity and disclosure of sexual orientation in general practice on lesbian, bi+ and queer cisgender women’s engagement with mental health services

“…General practitioners (GPs) provide accessible health promotion, primary physical and mental health care and referral to specialist mental health providers. Continuity of care is a core component of quality general practice care, with studies of the general population showing that people who access multiple GPs report lower levels of preventive health screening, satisfaction with care and confidence in their doctors (Glenister et al 2021). GPs are the most frequently accessed health professionals among LBQ+ cisgender women (McNair and Bush 2016), yet this group still remains less likely than heterosexual cisgender women to report care satisfaction and continuity with their GP (McNair et al 2011) Importantly, non-disclosure of minoritised sexual orientation in general practice has been associated with poorer care continuity (McNair et al 2015), access to mental health services (McNair and Bush 2016) and psychosocial wellbeing (Durso and Meyer 2013).…”