Medications

January/February 2013

FocusMedications

Prescribing by GP age

Volume 42, No.1, January/February 2013 Pages 11-11

Christopher Harrison

Joan Henderson

Helena Britt

The Australian medical workforce is growing as we seek to meet the clinical demand of an ageing population.1 It is expected that younger general practitioners will gradually replace older retiring GPs. Using BEACH data (April 2009 to March 2012) we compared 439 GPs aged less than 40 years (younger GPs) and 697 GPs aged 60+ years (older GPs) to determine whether there were differences between the two groups – particularly in terms of prescribing (Table 1).

Younger GPs were more likely to be female, hold FRACGP, be an Australian graduate and work in a group practice. Older GPs were more likely to manage patients who: were male, were aged 45+ years, held a Commonwealth healthcare card (HCC) or Veterans’ Affairs card; were from a non-English speaking background (NESB); were visited at home or at a residential aged care facility; had been previously to the practice. There was no difference in the number of problems managed at encounters, however, younger GPs managed more new problems while older GPs managed more chronic problems.

Table 1. BEACH GPs: April 2009 to March 2012
CharacteristicGPs aged <40 years (95% CI)GPs aged 60+ years (95% CI)
GPProportion
Female 58.1%    (53.5–62.7) 18.7%    (15.8–21.5)
FRACGP 83.1%    (79.5–86.6) 22.7%    (19.5–25.8)
Australian graduate 76.3%    (72.3–80.3) 62.9%    (59.3–66.5)
Solo practitioner 2.1%   (0.7–3.4) 22.2%    (19.1–25.3)
PatientProportion
Female 62.5%    (61.3–63.8) 54.4%    (53.5–55.3)
45+ years 44.0%    (42.5–45.5) 63.8%    (62.4–65.2)
HCC 35.2%    (33.4–37.0) 50.7%    (49.1–52.3)
Veterans’ Affairs card 1.9%   (1.7–2.1) 3.2%   (2.9–3.5)
NESB 5.5%   (4.2–6.7) 10.5%    (8.9–12.2)
New to practice 9.9%   (8.8–10.9) 7.6%   (6.9–8.3)
Aged care facility 2.4%   (1.8–3.1) 0.8%   (0.5–1.1)
Home or institutional visit 1.5%   (1.0–1.9) 0.4%   (0.3–0.6)
ManagementRate per 100 encounters
Problems managed
  • new problems
  • chronic problems
154.5  (151.8–157.1)
64.8    (62.9–66.7)
41.8    (39.8–43.7)
153.0 (150.4–155.7)
53.5    (52.0–55.0)
61.7    (59.4–64.1)
Medications
  • prescribed
  • advised OTC
  • GP supplied
98.6    (96.2–101.0)
71.9    (69.7–74.2)
13.2    (12.2–14.1)
13.5    (12.3–14.7)
112.4 (108.9–115.8)
94.5    (91.2–97.8)
8.0      (7.0–9.0)
9.9      (8.7–11.0)
Other treatments
  • clinical
  • procedural
66.4    (62.7–70.0)
43.8    (40.7–47.0)
22.5    (21.3–23.7)
48.0    (45.5–50.4)
29.2    (27.2–31.2)
18.7    (17.6–19.9)
Referrals
  • allied health
  • specialist
  • pathology
  • imaging
16.2    (15.4–16.9)
5.5      (5.1–5.9)
9.5      (9.0–9.9)
56.6    (54.0–59.1)
10.6    (10.1–11.1)
12.6    (12.0–13.2)
3.2      (3.0–3.5)
8.0      (7.6–8.4)
38.2    (36.3–40.1)
9.3      (8.9–9.8)

Older GPs recorded more medications overall, particularly those prescribed, while younger GPs recorded more supplied and advised for over-the-counter purchase medications. Older GPs recorded opioids at a higher rate, but the systemic antibiotic rate did not differ. Younger GPs provided more non-pharmacological treatments, such as clinical and procedural treatments and referrals, and ordered more imaging and pathology tests.

There are clear differences between the two groups of GPs, especially in their prescribing. While some of these differences may be explained by a higher proportion of young GPs being female,2 or older GPs seeing more older patients with more chronic problems, other behaviours may be unique to the older cohort and may not be replaced by the younger GPs. Further research measuring the impact of these differences on future general practice is required.

Competing interests: None.

Provenance and peer review: Commissioned; not peer reviewed.

Acknowledgements

The authors thank the GP participants in BEACH and all members of the BEACH team. Funding contributors to BEACH for April 2009–March 2012: Australian Government Departments of Health and Ageing and Veterans’ Affairs; Abbott Australasia Pty Ltd; AstraZeneca Pty Ltd (Aust); Bayer Australia Ltd; CSL Biotherapies Pty Ltd; GlaxoSmithKline Australia Pty Ltd; Janssen-Cilag Pty Ltd; Merck, Sharp & Dohme (Aust) Pty Ltd; Novartis Pharmaceuticals Australia Pty Ltd; Pfizer Australia; Sanofi-Aventis Australia Pty Ltd; Wyeth Australia Pty Ltd.

References

  1. Harrison C, Britt H. General practice – workforce gaps now and in 2020. Aust Fam Physician 2011;40:12–5.
  2. Harrison CM, Britt HC, Charles J. Sex of the GP – 20 years on. Med J Aust 2011;195:192–6.

Correspondence afp@racgp.org.au

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