The first 3 months

May 2012

FocusThe first 3 months

Infants

Encounters and management in general practice

Volume 41, No.5, May 2012 Pages 267-267

Janice Charles

Lisa Valenti

Helena Britt

At a BEACH (Bettering the Evaluation and Care of Health) consultation, up to three patient reasons for attending the encounter (RFE) and up to four diagnoses/problems managed can be recorded by the general practitioner. When there are multiple RFE and problems managed at an encounter, there is no direct link between the two. However, there is a direct association between the problem and its management. Medications can be recorded as prescribed, supplied or advised for over-the-counter purchase.

We analysed 2123 encounters with infants aged less than 4 months – recorded between January 2010 and December 2011 – for RFE, problems managed and type of management provided. About 1% of BEACH encounters are with patients in this age group.

Male infants accounted for 54% of these encounters, a significantly higher proportion than males at all BEACH encounters. Over one-quarter of RFE and problems managed were immunisation, with check-ups accounting for another 18%. Respiratory symptoms were also a common RFE, and upper respiratory tract infection (URTI) was a common diagnosis. Oesophageal reflux was the fourth most common diagnosis (Table 1, 2).

Table 1. Reasons for encounter
Reason for encounter % of RFE Rate per 100 encounters
Immunisation 25.5 34.3
Check-up 18.2 24.5
Cough 6.7 9.0
Nasal congestion 3.9 5.2
Rash 3.9 5.2
Irritable infant 3.1 4.2
Common cold 2.6 3.4
Fever 2.4 3.2

Table 2. Problems managed
Problem/diagnosis % of problems Rate per 100 encounters
Immunisation 27.2 34.3
Check-up 17.6 22.1
Acute URTI 7.6 9.6
Oesophageal reflux 3.7 4.7
Bronchitis/ bronchiolitis 2.9 3.6
Dermatitis 2.5 3.2
Infectious conjunctivitis 2.2 2.8
Irritable infant 1.3 1.7

Management

Medication rates were high, with about 68% supplied by the GP, 9% advised for over-the-counter purchase and only 23% prescribed. About three-quarters of these medications were the vaccines recommended by the immunisation schedule for infants less that 4 months of age. The most commonly recorded medication groups are shown in Table 3.

High rates of advice and counselling for the carer were recorded at these encounters. Topics ranged from advice on the problem being managed to advice on mothercare, prevention, nutrition and medication. Reassurance and support were also given frequently. Procedures were recorded frequently and most of these were injections.

Pathology orders were low (5.8 per 100 encounters). Of those that were recorded, urine and faeces tests were the most common. Imaging orders were rare (2.6 per 100 encounters), with ultrasound of the hip being the most common. Referrals were also given at a low rate (6.8 per 100 encounters) with 65% of these to paediatricians. Other referrals were to health clinics/centres, surgeons and ophthalmologists.

Table 3. Medications prescribed, supplied or advised
Medication group % of medications Rate per 100 problems
Vaccines 75.3 80.3
Topical steroid 3.1 3.3
Simple analgesics 2.9 3.1
Other skin products 2.5 2.7
Anti-infective eye 2.2 2.4
Broad spectrum penicillin 2.2 2.3
Topical nasal 1.9 2.1
Anti-ulcerants digestive 1.7 1.8

Acknowledgements

The authors thank the GP participants in BEACH and all members of the BEACH team. Funding contributors to BEACH in 2010 and 2011: Australian Government Department of Health and Ageing; AstraZeneca Pty Ltd (Australia); Bayer Australia Ltd; CSL Ltd; Glaxo SmithKline Australia Pty Ltd; Merck, Sharp and Dohme (Australia) Pty Ltd; Novartis Pharmaceuticals Australia Pty Ltd; Pfizer Australia; Sanofi–Aventis Australia Pty Ltd.

Correspondence afp@racgp.org.au

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