New PIP QI dataset provides ‘snapshot’ of general practice

A cursory review of the newly released Practice Incentive Program Quality Improvement (PIP QI) data would suggest chronic disease management in Australia has taken a hit.
 
The 2021–22 edition is only the second to have been released but every year-on-year measure captured by the data, which is compiled by Primary Health Networks (PHNs) and published by the Australian Institute of Welfare (AIHW), has stalled or gone backwards.
 
Designed to help improve patient care and inform planning for the health needs of Australians, the report compares general practice performance across 10 chronic disease management indicators like the recording of smoking status or flu immunisations for vulnerable cohorts.
 
But anyone using the numbers in isolation to form a judgement on the performance of general practice would be making a significant mistake, according to RACGP Expert Committee – Practice and Health System Reform (REC–PHSR) Vice Chair Dr Emil Djakic.
 
He told newsGP COVID-19 has had such a profound and unprecedented impact on Australia’s healthcare system that not taking its impacts into account would render the data ‘useless’.
 
‘It’s entirely corrupted by a change in patient behaviour and doctor workflow, particularly in the area of chronic disease management,’ he said.
 
‘We’ve been living in a once in a century health emergency … so I’m not surprised to see the number of clients with HbA1c’s not recorded has [increased], or that some of the immunisation stuff has fallen away.
 
‘This is a dangerous document for general practice, if it doesn’t recognise the environment that the data was generated in.’
 
Dr Djakic pointed out that over the past 12 months general practice has shouldered substantial responsibility for major elements of the national COVID response, including the vaccine rollout, at-home COVID management, and antivirals prescribing, all while managing ongoing workforce maldistribution issues.
 
‘Our practice energy has been totally skewed towards serving the public health emergency,’ he said.
 
‘That doesn’t mean we walked away from chronic disease management. But we started with a finite workforce and, for example, my practice over a period of two years did something like 18,000 extra vaccines.
 
‘So, we’re talking about a finite capacity that was charged with the responsibility of providing a pretty important contribution to what was the national health emergency.’
 
REC–PHSR Chair Dr Michael Wright holds a similar view.
 
He told newsGP the limited datasets and impact of the COVID makes it ‘difficult’ to form major conclusions but believes there is some value in the information.
 
‘Given the amount of change that GPs have dealt with, as well as having to focus on managing COVID, it’s remarkable that the care being providing remains as comprehensive as this,’ he said.
 
‘This is a snapshot of a small subset of the data collected in general practice, and it will show interesting trends over time.
 
‘It is good to see this information being made available to give us some insights into the value of general practice data, but it really is just a starting point.’
 
Dr Wright also suggested changes in patient behaviour help to explain the decrease in physical measurements, such as height and weight, over the past 12 months.
 
‘Lots of people would have only had telehealth consults or remote visits, so it’s not surprising that those numbers have dropped a little,’ he said.
 
‘I think that’s an important sign that we do need to remind patients that they may need to attend face-to-face consultations in order to obtain all the care they should.’
 
But while the data will likely prove more valuable in years to come, once longer term trends have been established, it is unclear how long it will take Australia’s healthcare system to recover from the impacts of COVID.
 
‘Our practice hasn’t had time to draw breath and what we’re seeing now is a wave of post-COVID mental health crashing on us,’ Dr Djakic said.
 
‘The community is very damaged, and it’s occupying a lot of our time.
 
‘Work as usual has been very hard to engage on and I think a lot of us have been very, very used up and consumed by what we’ve had to do.
 
‘A lot of the routine work, which needs to happen, is going to be hard to get back to with what we can see at the moment, which is workforce leaving the industry and capacities been quite denuded.’
 
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