Method
We analysed GP encounters with children aged <15 years that were collected in the Bettering the Evaluation and Care of Health (BEACH) program from April 2000 to March 2003 and April 2012 to March 2015, referred to as 2000–03 and 2012–15, respectively. The methods of the BEACH program are described in detail elsewhere.8 The average use of general practice services by children aged <15 years in the population was calculated using Medicare claims data (supplied by Australian Government Department of Health) and Australian Bureau of Statistics (ABS) population data.2 We used annual population estimates for June 2000 to June 2002 for 2000–03 calculations, and June 2012 to June 2014 data for 2012–15 calculations.
Results
GP encounters with children aged <15 years in BEACH accounted for a significantly smaller proportion of total consultations in 2012–15 (11.4%; 95% CI: 11.1–11.7) than in 2000–03 (12.9%; 95% CI: 12.6–13.2). Similarly, the proportion of the population aged <15 years decreased over the same period from 20.5% to 18.9%. By contrast, the population-based usage of general practice services in children was unchanged. For the period 2000–03, an average of 81.8% of children attended a GP at least once in each year, while in 2012–15 the average was 82.9%. In both periods, the average visit rate per head of population was 3.8 visits per year.
The types of problems commonly managed at encounters with children stayed relatively constant in 2000–03 and 2012–15, with upper respiratory tract infection (URTI), immunisation and ear infection the most common (Table 1). Management of problems classified as infections decreased from 56.8 (95% CI: 56.0–57.6) per 100 encounters with children in 2000–03 to 52.1 (95% CI: 51.3–53.0) in 2012–15. The most common infections for which management rates decreased included:
- acute otitis media/myringitis
- acute bronchitis/bronchiolitis
- tonsillitis
- gastroenteritis
- conjunctivitis.
The management rate of asthma also decreased significantly from 5.4 per 100 encounters in 2000–03 to 4.5 in 2012–15. The management rate of general check-ups and contact dermatitis increased over the period investigated (Table 1).
In terms of broad problem groups, respiratory conditions remained the most frequently managed, accounting for one-third of all problems managed. This did not change over time. General and unspecified problems (which include check-ups and immunisation) rose significantly from 22.9 (95% CI: 22.2–23.5) per 100 encounters to 25.6 (95% CI: 24.9–26.4). While psychological problems were not among the most frequently managed childhood problems, their management increased almost three-fold at encounters with children, from 1.7 (95% CI: 1.6–1.9) per 100 encounters in 2000–03 to 5.0 (95% CI: 4.6–5.4) per 100 encounters in 2012–15. This was reflected in increased management frequency of behavioural problems, anxiety, autism and attention-deficit hyperactivity disorder (results not tabled).
Table 1. Comparison of the childhood problems most frequently managed by GPs in 2000–03 and 2012–15
|
|
Problem managed
|
Rate per 100 encounters with children aged <15 years (95% CI)
|
|---|
|
2000–03 (n = 38,202)
|
2012–15 (n = 33,111)
|
|---|
|
Upper respiratory tract infection
|
16.7 (16.1–17.2)
|
16.2 (15.6–16.8)
|
|
Immunisation/vaccination – all*
|
11.5 (11.0–12.0)
|
11.0 (10.5–11.5)
|
|
Acute otitis media/myringitis
|
7.4 (7.1–7.7)
|
6.1 (5.8–6.5)
|
|
General check-up*
|
1.9 (1.7–2.1)
|
4.7 (4.4–5.0)
|
|
Asthma
|
5.4 (5.1–5.6)
|
4.5 (4.2–4.8)
|
|
Viral disease, other/NOS
|
4.0 (3.7–4.3)
|
3.7 (3.4–4.0)
|
|
Acute bronchitis/bronchiolitis
|
3.9 (3.6–4.1)
|
3.4 (3.1–3.6)
|
|
Dermatitis, contact/allergic
|
2.9 (2.7–3.0)
|
3.2 (3.0–3.4)
|
|
Tonsillitis*
|
4.0 (3.7–4.2)
|
3.0 (2.7–3.2)
|
|
Gastroenteritis*
|
3.2 (3.0–3.4)
|
2.5 (2.3–2.6)
|
|
Conjunctivitis
|
2.0 (1.9–2.2)
|
1.6 (1.4–1.7)
|
|
Note: problems managed are presented in 2012–15 order of frequency.
CI, confidence interval; n, number of encounters; NOS, not otherwise specified.
*Includes multiple ICPC-2 (International Classification of Primary Care, version 2) or ICPC-2 PLUS codes (see http://ses.library.usyd.edu.au//bitstream/2123/11882/5/Appendix4_YEAR_16.pdf)
|
Discussion
Our study allays the concern that children are being ‘crowded out’ from seeing GPs due to increased attendance by older patients. We found that children used general practice services at a similar rate in 2012–15 as they did in 2000–03. The shift in GP workload towards older patients is not at the expense of younger patients’ healthcare. The apparent decrease in encounters with children is due to an overall increase in the annual number of GP encounters. This increase is being driven by the rising number of older Australians who see their GP more often.9
The decreased management rates of infections and asthma, and increased management rates of contact dermatitis and psychological problems in children, reflect continuation of trends since the early 1990s identified in earlier research.6,7 To some extent, these trends reflect changes in management strategies (eg new medications, antibiotic awareness campaigns, introduction of initiatives including the GP Mental Health Care items) and, in the case of psychological problems, a global trend to recognise and manage mental health problems among children.7
The continued high management rate of immunisation and increased rate of general check-ups suggest that preventive care is a predominant feature of management of children in general practice. This is reassuring as one of the concerns raised about changing GP workload was that preventive care may be ‘crowded out’.1 The increase in check-ups may be due to the 2008 introduction of Medicare items for the ‘Healthy Kids Check’ in children aged 4 years.10 Funding for the Healthy Kids Checks items is due to cease from November 2015. It will be interesting to see if this leads to a decrease in check-ups among children.
Conclusion
The use of general practice services by children in the Australian population has remained constant, despite encounters with children accounting for a smaller proportion of the total GP workload in 2012–15 than in 2000–03. The increased share of GP time taken up by older patients has not come at the expense of time for children’s healthcare. The high management rate of immunisation and increasing rate of check-ups suggest preventive care is routinely delivered at encounters with children. Trends identified in the types of problems managed since the early 1990s are continuing (eg decreasing rates of infections and asthma). The results of our investigation led us to conclude that in Australia, in terms of their healthcare, the kids are alright.
Authors
Clare Bayram BAppSc (HIM) (Hons), PhD, Research Fellow and Project Manager, BEACH Program, Family Medicine Research Centre, University of Sydney, Sydney, NSW
Christopher Harrison BPsych (Hons), MSocHlth, Senior Research Analyst, Family Medicine Research Centre, University of Sydney, NSW
Janice Charles BA, MSc (Med), Senior Researcher, Family Medicine Research Centre, University of Sydney, NSW
Helena Britt BA, PhD, Director Family Medicine Research Centre, University of Sydney, NSW
Competing interests: None.
Provenance and peer review: Commissioned, externally peer reviewed.
Acknowledgements
We wish to thank the general practitioners who participated for their generosity. During the data collection period of this study, the BEACH program was funded by the Australian Government Department of Health, AstraZeneca Pty Ltd (Australia), Novartis Pharmaceuticals Australia Pty Ltd, bioCSL (Australia) Pty Ltd, AbbVie Pty Ltd, Merck Sharp & Dohme (Australia) Pty Ltd, Pfizer Australia Pty Ltd, Sanofi-Aventis Australia Pty Ltd, GlaxoSmithKline Australia Pty Ltd, National Prescribing Service Ltd, Janssen-Cilag Pty Ltd, Abbott Australasia Pty Ltd, Roche Products Pty Ltd, Bayer Australia Ltd, Wyeth Australia Pty Ltd, and the Australian Government Department of Veterans’ Affairs. Funding organisations had no editorial control over any aspect of this article.