Sexual health problems managed in Australian general practice: a national, cross sectional survey

Abstract

Objectives: To ascertain how frequently Australian general practitioners (GPs) identify sexual health (SH) problems, to gain understanding of how SH problems are managed in general practice and to determine the characteristics of GPs who manage them. Methods: A secondary analysis of data from the BEACH programme April 2000-March 2003. BEACH is a cross sectional national survey of GP activity: approximately 1000 GPs per year, each records details of 100 consecutive patient encounters. Initially, patient reasons for encounter (RFE), suggestive of a SH problem, were used to derive a list of SH problems (that is, doctor's diagnosis/problem label). Management of these problems was then investigated for all encounters with patients aged 12-49 years. The frequency of SH problems, their management and the characteristics of GPs managing them, were analysed using SAS. Results: During 299 000 encounters with 2990 GPs, 3499 (1.17 per 100 encounters) STI/SH problems were managed, the majority (81.1%) in females. The most common in women were genital candidiasis, vaginal symptoms, urinary symptoms, and intermenstrual bleeding, and in men were testicular symptoms, genital warts, and urethritis. Tests to exclude specific STIs were seldom taken and symptomatic management was common. GPs managing SH problems were younger, more likely to be female, have fewer years in practice, work in larger practices; hold FRACGP status (all p = ,0.001) than those GPs who managed none. Conclusion: Patients seeking medical attention for SH problems are often managed by GPs. Tests to diagnose or exclude specific sexually transmitted infections are seldom ordered and symptomatic management is common. Strategies to improve management of SH problems in general practice need to be developed and evaluated.

Prevalence of Recurrent Vulvovaginal Candidiasis in 5 European Countries and the United States

“…Although a study in the Netherlands suggests that Internet panel surveys do not accurately represent the distribution of ethnic minorities, political parties, and religious groups [16], VVC prevalence estimates were consistent across countries, despite varying response rates. Furthermore, estimates were very similar to that reported in the 2000 random digit dialing survey from the United States [2] and that of general practitioner practices in Australia [17]. Moreover, our estimates of RVVC are consistent with that reported in follow-up studies in Iowa [4] and Italy [5].…”

Management rates of sexually transmissible infections by Australian general practitioners, 2000–2012

“…This aligns with our previous findings that younger GPs are more likely (than older GPs) to manage patients with STIs and sexual health problems, and to test patients for chlamydia and HIV. 6,7 The higher proportion of GPs who were in the 60 years or over age group in Period 2 compared with Period 1 is consistent with the aging of the practising GP population in Australia over time, which is reflected in the representative GP samples drawn each year in BEACH. 20 The strengths of this study are that: (a) BEACH is an encounter-based database, reflecting the true clinical workload of general practice; (b) the random sampling of GPs, with weighting of data in analyses where appropriate, ensures that BEACH data are representative of the activities of all practising GPs in Australia; 2 and (c) the relatively large number of encounters sampled (over 1 million) improves the precision of the results compared with smaller studies.…”

“…For each problem, the management rate per 100 000 encounters was separately calculated for each of the two 6 Further analyses were performed on the combined data of the full 12-year time span April 2000 -March 2012.…”

“…1 Despite this, tests to diagnose or exclude specific STIs are seldom ordered by GPs and symptomatic management is common. 6 In a study by Johnston and colleagues over the period 1998-2001, researchers found that, at 303 000 GP-patient encounters, GPs managed only 521 STI problems. 7 The most frequently managed STIs were viral, including genital herpes (herpes simplex virus (HSV); 80 per 100 000 encounters) and genital warts (70 per 100 000 encounters); bacterial and protozoal STIs were rarely managed.…”

“…They were likely to have been in practice for a shorter period, to work fewer sessions per week and to work in larger practices. 6,7 There have been significant changes both in the diagnostic technologies available and in the epidemiology of STIs in the last decade or so. An evidence-based approach is required to determine priorities for GP workforce development, populationbased health promotion, access to medical care and health service planning strategies.…”