Gallbladder disease was managed at a rate of 0.2 per 100 encounters in BEACH, suggesting approximately 380 000 GBD patient-doctor encounters nationally per year. Gallbladder disease was managed significantly more often among women (at 0.22% of their encounters) than among men (0.15%), reflecting its higher prevalence in women. However, there was no significant change in the age-specific management rate, with patients in all age groups from 25 years onward having similar likelihood of GBD management.
Management
More than half (54.4%) of the GBD problems managed were new problems, a significantly larger proportion than the average for all problems (38.1%) recorded in BEACH in 2011–12.4 Medications were prescribed, advised for over-the-counter purchase, or supplied by the GP at a rate of 42.6 per 100 GBD problems, significantly lower than average for all problems (69.6) in BEACH. The most common medications were the analgesic, paracetamol/codeine and the anticholinergic, hyoscine butylbromide. Clinical treatments were provided at a rate of 25.2 per 100 GBD problems, advice and counselling about nutrition and weight, counselling about the problem, and advice and education being most common (Table 1).
Table 1. Details of gallbladder disease management
| Management type | Rate per 100 GBD
problems (n=559) |
|---|
| Medications (all) |
42.6 |
|
|
6.4 |
|
|
6.1 |
| Clinical treatments |
25.2 |
- Counselling/advice – nutrition/weight
|
9.7 |
|
|
4.3 |
|
|
4.1 |
| Specialist referral |
26.8 |
|
|
22.0 |
- Referral gastroenterologist
|
2.9 |
| Imaging |
40.6 |
|
|
37.0 |
| Pathology |
64.4 |
|
|
15.0 |
|
|
14.8 |
- Electrolytes, urea and creatinine
|
5.2 |
Referrals to specialists were frequent, given at a rate of 26.8 per 100 GBD problems: the vast majority (93.0%) being to surgeons (82.0%) and gastroenterologists (10.7%). The referral rate for GBD problems was significantly higher than the BEACH 2011–12 average for all problems (5.6 per 100 problems). Imaging tests were ordered at a rate of 40.6 per 100 GBD problems, substantially higher than the average for all problems (6.6). Ultrasounds accounted for more than 90% of imaging tests ordered. Similarly the order rate of pathology tests (64.4 per 100 GBD problems) was much higher than average (30.6). Full blood count, liver function, and electrolyte, urea and creatinine were the most commonly ordered tests (Table 1).
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Provenance and peer review: Commissioned; not peer reviewed.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 between January 2010 and December 2012: Abbott Australasia Pty Ltd; Australian Government Department of Health and Ageing; AstraZeneca Pty Ltd (Australia); Bayer Australia Ltd; CSL Biotherapies Pty Ltd; GlaxoSmithKline Australia Pty Ltd; Janssen-Cilag Pty Ltd; Merck Sharp and Dohme (Australia) Pty Ltd; Novartis Pharmaceuticals Australia Pty Ltd; Pfizer Australia; Sanofi-Aventis Australia Pty Ltd; Wyeth Australia Pty Ltd.