Health behaviours of many 45-64 year olds ‘do not bode well’
An acclaimed but now-shelved program of The University of Sydney has left a valuable legacy to general practice in Australia, with its final two reports on the clinical activity of GPs focusing on the impact of chronic disease and health status of 45-64 year olds.
After 18 years of continuous data collection the Bettering the Evaluation and Care of Health project, known as BEACH, closed recently. It was run out of the Family Medicine Research Centre in the Sydney School of Public Health, and its mine of data will continue to be available at the FMRC website.
The latest BEACH reports, General Practice Activity in Australia 2015–16 and a decade of general practice activity 2006–07 to 2015–16, provide a valuable snapshot of the changing demands on practitioners, even if they deliver few surprises.
The most predictable finding is that the continued ageing of the population fosters a rise in the incidence of chronic disease and in consequence, an increasing demand for GP services.
For example, in 2015–16, GPs managed 154 problems per 100 patient encounters, significantly more than a decade earlier (149 per 100 patient encounters). The reports also reveal that GPs managed 67 million more problems at patient encounters in 2015–16 than they did in 2006–07.
Compared to 2006-07, GPs provided:
- 31 million more prescriptions
- 25 million more clinical treatments (e.g. advice and counselling)
- 10 million more procedures
- 5 million more referrals to medical specialists
- 5 million more to allied health services
- 24 million more pathology tests/test battery orders
- 6 million more imaging tests
This year’s annual report includes a focus on the care of middle-aged Australians (45 to 64 years), enhancing the information provided in last year’s focus on the 65+ demographic.
The section on Care of middle-aged Australians in general practice reports that in 2015–16, compared with the average Australian, people aged 45–64 years had:
- 9% more GP encounters
- 14% more clinical face-to-face time with GPs
- 16% more problems manage
- 16% more medications prescribed/advised or supplied
- 31% more tests ordered
- 20% more referrals made.
However, patients aged 65 years or older used more again.
The reports reveal that 60 per cent of middle-age Australians (about 3.5 million) have at least one diagnosed chronic condition, 37 per cent have two (about 2.2 million), and one-in-five (about 1.2 million) have three or more chronic conditions.
It was found that 9 per cent of presenting patients in this age bracket had six or more diagnosed chronic conditions.
According to Professor Helena Britt, lead investigator of the two reports, the figures indicate that the 1.2 million middle-age Australians aged 45 to 64 who have three or more chronic conditions could benefit from the Federal government’s proposed ‘Health Care Home’ initiative.
The most common ‘pair’ of diagnosed chronic conditions in this group are hypertension and hyperlipidaemia – one in 10 surveyed patients and one in 15 in the population having both. The most common combination of three diseases was hypertension, hyperlipidaemia and osteoarthritis.
Since people with diagnosed chronic conditions visit healthcare providers more often than an average person, the findings have implications for future rates of consultation to GPs, specialists and allied health professionals – and associated costs to Medicare.
However, this extra spending should improve patients’ overall health and potentially reduce avoidable hospitalisations, which incur much bigger costs than the extra care provided in general practice.
The reports also show that people in the 45–64 year age-group have high rates of risk behaviours: in 2015–16, more than 70 per cent of these people were either overweight or obese, with the proportion that were morbidly obese more than doubling, from 3 per cent to 6 per cent over the study period.
Further, over the past 16 years (2000–01 to 2015–16), there has been a steady increase in people moving ‘up the obesity scale'.
“While prevalence of daily smoking and hazardous alcohol consumption fell significantly among all adult patients, there was no change in smoking and alcohol use in the 45–64 year age group.
“Around one in five middle-aged people aged 45-64 remain daily smokers and one in four drink alcohol at hazardous levels,” Professor Britt said.
"These results do not bode well for the future health of this age group of patients visiting GPs.
“We need more research to understand why clinical and public health programs haven’t affected their lifestyle choices. Perhaps enrolment in health care homes and some targeted lifestyle programs could assist 45–64 year olds in the management of their chronic disease load.”
