Study finds administrative general practice visits represent hidden value

Amanda Lyons

20/02/2018 3:20:57 PM

Research published in the Medical Journal of Australia supports the value and importance of administrative visits to the GP.

Research found that administrative GP visits often provide an opportunity for further provision of healthcare, as well as greater care planning and coordination.
Research found that administrative GP visits often provide an opportunity for further provision of healthcare, as well as greater care planning and coordination.

The interim report by the Medicare Benefits Schedule (MBS) Review Taskforce, released in 2016, stated that, ‘GP consultations considered to be administrative rather than diagnostic or treatment-focused were commonly cited as low value by health professionals and consumers.’
This sparked a debate between politicians and the primary healthcare community over the issue of ‘low-value’ visits to the GP, which in turn inspired a group of researchers from the Bettering the Evaluation and Care of Health (BEACH) research project to investigate further.
‘There had been discussion about GPs being overly burdened and that ‘low-value’ consults were blowing out the budget,’ Professor Lyndal Trevena, Professor of Primary Health Care in the School of Public Health at Sydney Medical School, told newsGP.
‘We set out to explore whether these consults were actually low value, and we think we found that’s not the case.’
Professor Trevena and her research colleagues used BEACH data on GP activity in Australia, collected from close to 1000 randomly sampled GPs each year between April 2000 – March 2016, in ‘Administrative encounters in general practice: Low value or hidden value care?’.
To investigate the question of low-value or administrative consultations, the researchers first defined the contents of an administrative consultation, dividing them into three types: paperwork requests, including certificates for sickness or fitness to drive; requests for referral to other specialists; and requests for medication or test results.
The study found there were relatively few general practice encounters – 7.4% – focused solely on administrative requests.
‘It was a very small proportion of encounters,’ Professor Trevena said. ‘And even when potentially low-value care requests were the only reason patients came, most of the time they got other things anyway; for example, having their hypertension checked or blood tests ordered to monitor their medication.’
In fact, such administrative visits can often provide an opportunity for further provision of healthcare.
‘So-called “low-value” consultations often become gateways for a more holistic examination of the patient’s health,’ RACGP President Dr Bastian Seidel told newsGP.
Slightly more than a third of administrative visits (35.4%) were found to be centred around care planning and coordination.
‘With the growing burden of chronic disease, we would expect to see people doing quite a lot of care planning and coordination, and the data backs that up,’ Professor Trevena said.
Overall, Professor Trevena and her colleagues believe the data supports a view in which administrative visits actually represent a hidden value within general practice.
‘If you come in to a GP with a request for one thing and you walk out from a 15-minute appointment with a whole lot more, that’s actually cost-saving. You are getting pretty good value,’ Professor Trevena said.
The message Professor Trevena would like to get across to policy-makers is to investigate fully before administering budget cuts to the health system.
‘Before jumping to conclusions about something that might look low-value on the surface, try and look a bit further. You don’t want to throw the baby out with the bathwater,’ she said.
‘I understand healthcare costs; we need to be sustainable about those for the future. But it would be such a shame if some of these golden opportunities and good value things in general practice were lost because we didn’t recognise the hidden value that was there.’
Dr Seidel agrees and would like to see the value of general practice recognised in federal funding.
‘This research confirms the good value that GPs provide in Australian healthcare. In fact, it is a bargain,’ he said. ‘We know that preventive healthcare provides far more efficient results than spending solely on hospital care.
‘MBS rebates need to recognise the real value to patients and society at large. That’s why the RACGP recommends an 18.5% increase of the Medicare rebate for specialist GP consultations.’ 

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