The latest results of Australia’s longest running study of general practice activity has found that older Australians account for the nation’s highest use of primary care resources, and the proportion they are using is increasing over time.
However, the money is well spent, lowering overall health care costs by reducing expensive specialist and hospital visits, and contributing to greater longevity.
Noting that in any one year, about 85 per cent of the population makes at least one contact with a GP, The University of Sydney’s Bettering the Evaluation and Care of Health (BEACH) analysis focused closely on the highest users of GP services - older Australians.
The analysis of the 2014-15 data compared the amount of GP health resources older people used with this age group’s representation in the population.
The USyd team* found that while 65+ year-olds accounted for 14.7 per cent of Australians, they registered 27.8 per cent of all GP interactions, 28.7 per cent of GP clinical face-to-face time, 35.0 per cent of all problems managed, 35.8 per cent of all medications used, 30.8 per cent of all imaging and pathology tests ordered, and 32.2 per cent of all referrals.
In short, around 15 per cent of people used about twice as many health resources as the average Australian.
“We also found that older people had more diagnosed chronic conditions than younger people,” the researchers said.
“Having multiple diagnosed chronic conditions increases both the complexity of the patient’s care and the resulting health resource use. We found that 60 per cent of people aged 65+ in the population had three or more diagnosed chronic conditions and one-in-four had five or more.
“One-third of older patients at GP encounters were living with chronic pain…
Older patients were taking more medications (just over five on average) which is known to increase the risk of adverse drug reactions.”
On international comparisons, they found that Australia’s total health care spending is similar to comparable countries such as the UK, Canada and NZ, and we have one of the world’s longest life expectancies.
While Australia spends about half the USA’s per capita outlay on health, our life expectancy is four years longer (83 years versus 79 years).
This may well be because primary care is the core of Australia’s system, with GPs acting as what the team called the “gatekeepers” to more expensive care.
“We found nearly all older patients (98.6%) have a regular general practice… This provides GPs in that clinic with a shared patient health record which helps continuity of care. It also lowers the risk of test duplication and fragmentation of services.”
They said that if general practice were not at the core of our health care system, “it’s likely the overall cost of health care would be far higher.
It is generally accepted that early diagnosis and management of chronic conditions is part of quality health care.
“The combination of early diagnosis and our ever-increasing life expectancy means we have more chronic conditions being managed for longer, consuming a growing amount of health resources for their management.
“This is the price Australia pays for good health, but we would argue this price is very reasonable.”
The study concluded that, “General practices are in a prime position to act as the coordinators of care and help lower the chance of fragmented care. If our government wants to make our health care system sustainable, it should invest in primary care to improve the integration of, and communication between, these different parts of the health system.”
*Helena Britt, Graeme C Miller, Joan Henderson, Clare Bayram, Christopher Harrison, Lisa Valenti, Carmen Wong, Julie Gordon, Allan J Pollack, Ying Pan, Janice Charles
