Administrative encounters in general practice: low value or hidden value care?

Abstract

Objective: To determine the frequency of general practice administrative encounters, and to determine whether they represent low value care. Design: Secondary analysis of data from the Bettering Evaluation and Care of Health (BEACH) dataset. Setting: 1 568 100 GP–patient encounters in Australia, 2000–01 to 2015–16. Participants: An annual nationally representative random sample of about 1000 GPs, who each recorded the details of 100 consecutive encounters with patients. Main outcome measures: Proportions of general practice encounters that were potentially low value care encounters (among the patient's reasons for the encounter was at least one administrative, medication, or referral request) and potentially low value care only encounters (such reasons were the sole reason for the encounter). For 2015–16, we also examined other health care provided by GPs at these encounters. Results: During 2015–16, 18.5% (95% CI, 17.7–19.3%) of 97 398 GP–patient encounters were potentially low value care request encounters; 7.4% (95% CI, 7.0–7.9%) were potentially low value care only encounters. Administrative work was requested at 3.8% (95% CI, 3.5–4.0%) of GP visits, 35.4% of which were for care planning and coordination, 33.5% for certification, and 31.2% for other reasons. Medication requests were made at 13.1% (95% CI, 12.4–13.7%) of encounters; other health care was provided at 57.9% of medication request encounters, counselling, advice or education at 23.4%, and pathology testing was ordered at 16.7%. Referrals were requested at 2.8% (95% CI, 1.7–3.0%) of visits, at 69.4% of which additional health care was provided. The problems managed most frequently at potentially low value care only encounters were chronic diseases. Conclusion: Most patients requested certificates, medications and referrals in the context of seeking help for other health needs. Additional health care, particularly for chronic diseases, was provided at most GP administrative encounters. The MBS Review should consider the hidden value of these encounters.

The Association Between Continuity of Care With a Primary Care Physician and Duration of Work Disability for Low Back Pain

“…49 While it is reasonable for a jurisdiction to require a worker to be certified as unable to work, if the worker's usual PCP is not available, another PCP may be consulted. It is unlikely that all PCPs would simply perform an administrative service when consulted by an injured worker, 50 and this introduces the potential for the worker to receive conflicting advice, alterations to treatment, and increases the likelihood of having to relive the injury experience. Policies that enable or encourage workers to see the same PCP, or limit the need for workers to consult multiple PCPs, may ultimately be beneficial for workers' compensation systems by reducing working time loss and associated costs.…”

The Relationship between Continuity of Care with a Primary Care Provider and Duration of Work Disability in Workers with Low Back Pain: A Retrospective Cohort Study

“…While it is reasonable for a jurisdiction to require a worker to be certified as unable to work, if the worker's usual GP is not available another GP may be consulted. It is unlikely that all GPs would simply perform an administrative service when consulted by an injured worker 41 , and this introduces the potential for the worker to receive conflicting advice, alterations to treatment, and increases the likelihood of having to relive the injury experience. Policies that enable or encourage workers to see the same GP, or limit the need for workers to consult multiple GPs, may ultimately be beneficial for workers' compensation systems by reducing working time loss and associated costs.…”