Medical software data provides fresh insight into general practice

Hypertension, depression, anxiety disorder, lower back pain and gastro-oesophageal reflux disease (GORD) were the top five non-communicable conditions treated by GPs from July 2020 to June 2021, newly published nationwide figures indicate.
 
The 2020–21 General Practice Insights Report, based on 2.5 million patients’ de-identified data from the clinical software of consenting general practices, is the fifth in the series and reveals some of the effects the COVID-19 pandemic has had on Australian primary care.
 
Released by MedicineInsight, a program managed by NPS MedicineWise, the report covers 10.8% of all Australian GPs and 11.4% of all patients seen by GPs nationally and contains a number of fascinating insights, according to GP and NPS MedicineWise spokesperson Dr Caroline West.
 
‘It’s a great resource for primary healthcare and to get a sense of what’s happening at a community level,’ she told newsGP.
 
‘We are dealing with a lot of chronic conditions and people often have more than one condition.’
 
Overall data insights
More than 14 million clinical encounters were included in the report, which collates information on demographics, diagnoses, pathology and radiology requests, and COVID effects.
 
The top five non-communicable conditions seen by GPs in 2020–21 have not changed since the previous report, and hypertension has topped the list every year since the reports began.
 
The report also captures all written prescriptions – whether private, subsidised or under co-payment – providing a more complete picture than PBS data, which excludes private prescriptions.
 
The most frequently prescribed total prescriptions were medicines for long-term conditions such as depression, dyslipidaemia and GORD.
 
Medications for the nervous system, including antidepressants and analgesics, accounted for the largest proportion of issued prescriptions at 29.5%, while cardiovascular medicines, such as antihypertensives and lipid-lowering medicines, comprised the largest proportion of total prescriptions (issues plus repeats) at 32.2%.
 
On average, every 100 GP clinical encounters resulted in 67.5 issued prescriptions and 218.7 total prescriptions.
 
According to the report, 85.1% of dispensed medicines during this period were subsidised by the Australian Government.
 
‘This means a lot of people are getting their medicines privately,’ Dr West said.
 
Among other findings, 82.8% of patients over 18 years of age had their smoking status recorded at least once in their medical history and 27.7% had their alcohol use recorded at least once.
 
Body mass index (BMI) or both height and weight was recorded for 35.3% of patients of all ages. Weight was recorded for 42.8% of patients of all ages.
 
However, some GPs may record BMI, smoking or alcohol use in different sections in the medical record that are not available to MedicineInsight, such as progress notes, and it is possible that these figures may underestimate recording of risk factors.
 
Alternatively, increasing use of telehealth during the pandemic may have impacted upon the recording of risk factor information.
 
‘[The findings] highlight some gaps where we could do better,’ Dr West said. ‘For example … how much data we’re collecting on alcohol consumption, which is at only 27%.
 
‘Sometimes it’s added in free text, as opposed to putting it in the designated section of the medical record.’
 
COVID effects
Patients visited their GP more during the pandemic years, 2020 and 2021, than in 2019.
 
Telehealth consultations peaked in April 2020 with 269 per 1000 clinical encounters, before rising and falling in line with new COVID-19 outbreaks and corresponding lockdowns.
 
‘At the start of COVID, there was a quick adaptation to telehealth,’ Dr West said.
 
There were 10,996 patients with a recorded diagnosis of COVID infection during calendar years 2020 and 2021. Among these, 73% lived in a major city and 86% were from New South Wales or Victoria.
 
Rates of COVID vaccination peaked in August and September 2021.
 
There were higher rates of mental illness presentations in 2020 compared to 2019, but they fell to below 2019 rates in 2021.
 
‘The drop in 2021 may be more complicated, because like with the alcohol and BMI sections, the condition has to be put in the appropriate box,’ Dr West said.
 
‘Lots of people are coming in distress, but it may be entered as free text or if they don’t need a referral to psychologist or a GP mental health plan, it’s not captured.’
 
Rates of sexually transmitted infection testing were also lower in 2020 and 2021 compared to 2019.
 
However, prescription rates spiked at the beginning of the pandemic in March 2020 for many medicines, likely as a result of stocking up.
 
‘[Initially], there was stockpiling of all medicine classes we studied. Prescribing then returned to normal for most classes,’ Dr West said.
 
‘Prescribing for some medicine classes, however, didn’t return to normal levels.
 
‘Since April 2020 doctors have been prescribing fewer antibiotics. This was particularly striking during major lockdowns. An explanation could be that people had fewer respiratory infections due to public health measures implemented during lockdowns.’
 
There were 11.1 total prescriptions of antibiotics and prednisolone per 100 encounters in 2020–21, compared to 15.7 in 2019–20. This decrease is consistent with PBS data, which was driven by reductions in antibiotics indicated for treatment of respiratory infections.
 
‘There’s been a tremendous drop, likely from social distancing, working from home, masks and handwashing,’ Dr West said.
 
In relation to preventive care, there were no differences in the rates of Aboriginal and Torres Strait Islander health assessments in 2020–21 compared to 2019–20.
 
Cervical screening tests rates were consistently lower in 2020–21 compared with the previous 12 months, but this could be related to a change in national guidelines that more than doubled the screening schedule to five years, whereas before 2019 it was biennial.
 
Faecal occult blood test rates also remained unchanged through the pandemic years compared to 2019.
 
At more 100 pages, the MedicineInsight data will likely provide ongoing valuable information for general practice and trends in community health in years to come – particularly in helping to judge the overall impact of the pandemic, Dr West believes.
 
‘The MedicineInsight dataset could be a valuable resource for exploring the impact of COVID on long-term health in the future,’ she said.
 
‘But what it shows is that even with COVID, a lot of people kept continuity in their healthcare.’
 
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