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Background: At the beginning of the COVID-19 pandemic, it was foreseen that the number of face-to-face psychiatry consultations would suffer a reduction. In order to compensate, the Australian Government introduced new Medicare-subsidized telephone and video-linked consultations. This study investigates how these developments affected the pre-existing inequity of psychiatry service delivery in Australia., Methods: The study analyses five and a half years of national Medicare data listing all subsidized psychiatry consultation consumption aggregated to areas defined as Statistical Area level 3 (SA3s; which have population sizes of 30 k-300 k). Face-to-face, video-linked and telephone consultations are considered separately. The analysis consists of presenting rates of consumption, concentration graphs, and concentration indices to quantify inequity, using Socio Economic Indexes for Areas (SEIFA) scores to rank the SA3 areas according to socio-economic disadvantage., Results: There is a 22% drop in the rate of face-to-face psychiatry consultation consumption across Australia in the final study period compared with the last study period predating the COVID-19 pandemic. However, the loss is made up by the introduction of the new subsidized telephone and video-linked consultations. Referring to the same time periods, there is a reduction in the inequity of the distribution of face-to-face consultations, where the concentration index reduces from 0.166 to 0.129. The new subsidized video-linked consultations are distributed with severe inequity in the great majority of subpopulations studied. Australia-wide, video-linked consultations are also distributed with gross inequity, with a concentration index of 0.356 in the final study period. The effect of this upon overall inequity was to cancel out the reduction of inequity resulting from the reduction of face-to face appointments., Conclusion: Australian subsidized video-linked psychiatry consultations have been distributed with gross inequity and have been a significant exacerbator of the overall inequity of psychiatric service provision. Future policy decisions wishing to reduce this inequity should take care to reduce the risk posed by expanding telepsychiatry., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yeatman, Enticott, Lakra and Meadows.)

Objective: To determine: 1) the mean, median and range of fees for initial and subsequent private outpatient consultations with a general paediatrician in Australia; 2) any variation in fees and bulk billing rates between states/territories; and 3) volume of outpatient general paediatric specialist consultations relative to child population., Methods: Analysis of Medicare claims data from the years 2011 and 2014 for initial consultations (items 110 and 132), subsequent consultations (items 116 and 133), and autism or pervasive developmental disorder (PDD) initial consultation (item 135) with a general paediatrician., Results: Fees for initial and subsequent general paediatric outpatient consultations varied within, and between, states and territories. Fees increased slightly from 2011 to 2014, after accounting for inflation. The volume of consultations relative to child population varied markedly across states and territories, as did bulk billing rates. Use of item codes for patients with multiple morbidities (132 and 133) increased significantly from 2011 to 2014. Autism/PDD consultation service use (item 135) and fees remained relatively stable., Conclusions: There was variation in service use, fees and bulk billing within, and between, states and territories, and across time and consultation types. Implications for public health: Future studies should assess the impact of such variation on access to paediatric services and the relationship, if any, to variation in state investment in public paediatric outpatient services., (© 2018 The Authors.)

Objectives: To describe patterns of frequent attendance in Australian primary care, and identify the prospective risk factors for persistent frequent attendance., Design, Setting and Participants: This study draws on data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study of residents from the Canberra region of Australia. Participants were assessed on 3 occasions over 8 years. The survey assessed respondents' experience of chronic physical conditions, self-reported health, symptoms of common mental disorders, personality, life events, sociodemographic characteristics and self-reported medication use. A balanced sample was used in analysis, comprising 1734 respondents with 3 waves of data. The survey data for each respondent were individually linked to their administrative health service use data which were used to generate an objective measure of general practitioner (GP) consultations in the 12 months surrounding their interview date., Main Outcome Measures: Respondents in the (approximate) highest decile of attenders on number of GP consultations over a 12-month period at each time point were defined as frequent attenders (FAs)., Results: Baseline FAs (8.4%) were responsible for 33.4% of baseline consultations, while persistent FAs (3.6%) for 15.5% of all consultations over the 3 occasions. While there was considerable movement between FA status over time, consistency was greater than expected by chance alone. While there were many factors that differentiated non-FAs from FAs in general, persistent frequent attendance was specifically associated with gender, baseline reports of depression, self-reported physical conditions and disability, and medication use., Conclusions: The degree of persistence in GP consultations was limited. The findings of this study contribute to our understanding of the risk factors that predict subsequent persistent frequent attendance in primary care. However, further detailed investigation of longitudinal patterns of frequent attendance and consideration of time-varying determinants of frequent attendance is required., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: A recent study has suggested that overweight and obese people are more likely to consult a range of physicians (doctor shopping). The consistency of this finding with multiple measures of doctor shopping and controls for socioeconomic circumstances was interrogated., Design and Methods: Ninety-nine thousand four hundred seven Australians aged 45 and over who had sought primary healthcare at least five times within 6 months of a survey (2006-2008). (i) The count of different physicians consulted; a binary indicator of (ii) >= three different physicians; (iii) >= five different physicians; and iv) a measure that took into account multiple consultations with the same physician were investigated. Weight status was measured using Body Mass Index (BMI) based on self-reported height and weight. Controls included socioeconomic circumstances, demographics, health, and neighborhood factors., Results: In comparison to people with "normal" BMI, the likelihood of doctor shopping was lower among overweight (Incidence Rate Ratio: 0.97, 95%CI: 0.96, 0.98) and obese people (0.95: 0.93, 0.96). This negative correlation between doctor shopping behavior and weight status was consistent after full adjustment and across different outcome measures., Conclusions: In contrast with recent evidence from the US, overweight and obese Australians are less prone to doctor shopping behavior than their peers with "normal" BMI., (Copyright © 2013 The Obesity Society.)

Objectives: To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines., Design, Participants and Setting: A before-and-after study to analyse prospectively collected data on 577 patients with type 1 or 2 diabetes mellitus who were managed with a GPMP created using cdmNet between June 2008 and November 2012., Main Outcome Measures: Completion of the clinical tests in the ACOC (process outcome) and values of six of these clinical measurements (clinical outcomes)., Results: Significant improvements were seen after creation of a GPMP in the proportion of ACOC clinical tests completed (57.9% v 74.8%, P < 0.001), total cholesterol level (P < 0.01), low-density lipoprotein (LDL) cholesterol level (P < 0.001) and body mass index (BMI) (P < 0.01). Patients using GPMPs and TCAs also improved their glycated haemoglobin (HbA1c) level (P < 0.05). Patients followed up with irregular reviews had significant improvements in the proportion of ACOC clinical tests completed (59.2% v 77.6%, P < 0.001), total cholesterol level (P < 0.05), and BMI (P < 0.01), but patients with regular reviews had greater improvements in the proportion of ACOC clinical tests completed (58.9% v 85.0%, P < 0.001), HbA(1c) level (57.7 v 53.0 mmol/mol, P < 0.05), total cholesterol level (4.8 v 4.5 mmol/L, P < 0.05), LDL cholesterol level (2.8 v 2.4 mmol/L, P < 0.01) and diastolic blood pressure (76.0 v 74.0 mmHg, P < 0.05)., Conclusion: There were significant improvements in process and clinical outcomes for patients on a GPMP or a GPMP and TCA, particularly when these were followed up by regular reviews. Patients using cdmNet were four times more likely to have their GPMP or TCA followed up through regular reviews than the national average.

Background: The evidence on the agreement between self-reported health resource use and administrative records is mixed and no gold standard exists. The objective of this study was to assess self-reported general practitioner (GP) and specialist doctor visits, as well as medication use via telephone interview against national insurance administrative data for colorectal cancer survivors., Methods: In a sample of 76 adults recently diagnosed with colorectal cancer, data was abstracted from telephone survey items on GP visits, specialist visits and medication use over the previous six months and compared with data on the same individuals from administrative data. Intraclass correlation coefficients (ICC) were used to assess the reliability of frequency of visits and kappa statistics were derived for four broad categories of medicines used for gastrointestinal conditions, cardiovascular disease, psychological conditions and chronic obstructive pulmonary disease. Logistic regression was undertaken to assess factors associated with agreement (yes/no) between the two data sources for doctors' visits., Results: Good agreement was found for GP visits (ICC 0.62, 95%CI: 0.38, 0.86) and specialist visits (ICC 0.73, 95%CI: 0.56, 0.91) across the two data sources. When costs were assigned to frequencies, mean costs for the two methods were not significantly different over six months. Over-reporting was more common among men and participants with frequent doctor encounters. Large discrepancies between self-reports and administration records were found for broad types of medications used (44% agreement, kappa 0.13)., Conclusion: Self-reported frequency of doctor's visits using telephone interviews may be a reasonable substitute for administratively recorded data however, medication use by self-report appears to be unreliable. Administrative records are preferable to self-report for health service use in colorectal cancer survivors with high and complex service needs.

Purpose: To develop more evidence-based guidelines for the frequency of patient follow-up after treatment of localized (American Joint Committee on Cancer [AJCC] stage I or II) melanoma., Methods: We used data from Melanoma Institute Australia on an inception cohort of 3,081 consecutive patients first diagnosed with stage I or II melanoma between January 1985 and December 2009. Kaplan-Meier curves and Cox models were used to characterize the time course and predictors for recurrence and new primaries. We modeled the delay in diagnosis of recurrence or new primary as well as the number of monitoring visits required using two monitoring schedules: first, according to 2008 Australian and New Zealand guidelines and, second, with fewer visits, especially for those at lowest risk of recurrence., Results: For every 1,000 patients beginning follow-up, 229 developed recurrence and 61 developed new primary within 10 years. There was only a small difference in modeled delay in diagnosis (extra 44.9 and 9.6 patients per 1,000 for recurrence and new primary, respectively, with delay greater than 2 months) using a schedule that requires far fewer visits (3,000 fewer visits per 1,000 patients) than recommended by current guidelines. AJCC substage was the most important predictor of recurrence, whereas age and date of primary diagnosis were important predictors of developing new primary., Conclusion: By providing less intensive monitoring, more efficient follow-up strategies are possible. Fewer visits with a more focused approach may address the needs of patients and clinicians to detect recurrent or new melanoma.

Objective: To assess the direct annual health care costs for children and adolescents with Down syndrome in Western Australia and to explore the variation in health care use including respite, according to age and disease profile., Study Design: Population-based data were derived from a cross-sectional questionnaire that was distributed to all families who had a child with Down syndrome as old as 25 years of age in Western Australia., Results: Seventy-three percent of families (363/500) responded to the survey. Mean annual cost was $4209 Australian dollars ($4287 US dollars) for direct health care including hospital, medical, pharmaceutical, respite and therapy, with a median cost of $1701. Overall, costs decreased with age. The decline in costs was a result of decreasing use of hospital, medical, and therapy costs with age. Conversely, respite increased with age and also with dependency. Health care costs were greater in all age groups with increasing dependency and for an earlier or current diagnosis of congenital heart disease. Annual health care costs did not vary with parental income, including cost of respite., Conclusions: Direct health care costs for children with Down syndrome decrease with age to approximate population costs, although costs of respite show an increasing trend., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Aim: To ascertain endodontist's point of view (treatment philosophy, rationale and preference) regarding single- and multiple-visit root canal treatment. To identify the basis on which the choice is made and how the information necessary for the choice is acquired., Methodology: Endodontists registered with the dental practice board of every state in Australia were contacted, and if they agreed to participate, they were interviewed either face to face or by telephone. The following topics were addressed in an interview lasting 15 to 20 min: demographics, current clinical procedures, treatment rationales and preference. A hypothetical scenario was posed to investigate which treatment regimen they would prefer to deliver if biological concerns were eliminated from consideration., Results: Fifty-two endodontists (71% of all Australian endodontists) agreed to participate in the study. Almost all (51/52) participants had performed single-visit root canal treatment, but very few routinely performed it. A majority of participants were willing to provide single-visit treatment where patients had time constraints, and in vital cases (including elective endodontics). The most powerful factor of influencing practice change was interpersonal contact with colleagues. Publications in academic journals have a weak influence in practice change., Conclusions: Australian endodontists strongly prefer multiple-visit over single-visit root canal treatment even in cases where biological concerns are not an issue. Operator preference rather than biological or patient considerations appear to be the primary determinant of treatment choice.

Objectives: To compare mix of patients, scope of practice, and duration of visit in primary care physicians in Australia, New Zealand, and the United States., Design: Comparison of three comparable cross sectional surveys performed in 2001-2. Physicians completed a questionnaire on patients' demographics, diagnoses, and duration of visit., Setting: Primary care practice., Participants: 79,790 office visits in Australia, 10,064 in New Zealand, and 25,838 in the US., Main Outcome Measures: Diagnostic codes were mapped to the Johns Hopkins expanded diagnostic clusters. Scope of practice was defined as the number of expanded diagnostic clusters accounting for 75% of all managed problems related to morbidity. Exposure to primary care was calculated from duration of visits recorded by the physician, and reports on rates of visits to primary care for each country., Results: In each country, primary care physicians managed an average of 1.4 morbidity related problems per visit. In the US, 46 expanded diagnostic clusters accounted for 75% of problems managed compared with 52 in Australia, and 57 in New Zealand. Correlations in the frequencies of managed health problems between countries were high (0.87-0.97 for pairwise comparisons). Though primary care visits were longer in the US than in New Zealand and Australia, the per capita annual exposure to primary care physicians in the US (29.7 minutes) was about half of that in New Zealand (55.5 minutes) and about a third of that in Australia (83.4 minutes) because of higher rates of visits to primary care in these countries., Conclusions: Despite differences in the supply and financing of primary care across countries, many aspects of the clinical practice of primary care physicians are remarkably similar in Australia, New Zealand, and the US.

Objectives: To examine the current practice and attitudes of Australian sexual health practitioners towards the use of chaperones for genital examinations., Methods: In July 2006, an anonymous, self-completed questionnaire was mailed to members of the Australasian Chapter of Sexual Health Medicine., Results: Of the 166 questionnaires sent to practitioners, 110 (66%) were returned completed. Of the 110 respondents, only 9% and 19% reported that their clinic routinely provided chaperones for all male and female genital examinations, respectively. Among practitioners whose services did not offer chaperones routinely, chaperones were offered with a mean frequency of 19% for female examinations and 8% for male examinations (P = 0.01). Compared to female practitioners, significantly more male practitioners thought a chaperone was important for medico-legal purposes when examining females (72% v. 53%, P < 0.05). Compared to male practitioners, significantly more female practitioners thought a chaperone was sometimes important for patient support when examining male patients (52% v. 26%, P < 0.001). Only 39% (n = 18) of male practitioners and 36% (n = 23) of female practitioners felt that resources spent on chaperones were justified by the benefits they provided., Conclusions: Despite only a minority of practitioners offering chaperones to patients or using them during examinations, many feel they are important for medico-legal reasons and as support for the patient. Best practice may be for services to routinely offer a chaperone and record instances where an offer is declined. This provides patients with choice and practitioners with some level of protection.

Objective: To measure the independent effect on length of general-practice consultations of a range of characteristics of the general practitioner (GP), practice, patient and consultation, as a basis for considering future GP workforce needs., Design: Secondary analysis of data from the BEACH (Bettering the Evaluation and Care of Health) study., Setting and Participants: Data were obtained from 1904 GPs Australia-wide on 70,758 consultations between 1 January 2001 and 31 December 2002; all consultations that were claimable from the Australian Government's Medicare system as General Practice Attendances and had recorded start and finish times were included., Main Outcome Variables: Characteristics of the GP, practice, patient and consultation that were significantly related to consultation length, determined by multiple regression analysis., Results: The following variables had an independent positive effect on consultation length: GP female, older, graduated in Australia, FRACGP-qualified, and in rural practice; patient female, older, new to practice, with higher socioeconomic status, no health concession card, more reasons for encounter, and more problems managed; and management of specific problem types (social, psychological and female genital problems), management of chronic disease, and provision of clinical treatments., Conclusion: The independent relationship of some GP, practice, patient and consultation characteristics with length of consultation may affect future GP supply. These factors should be considered in modelling future general practice workforce needs.

Objective: To examine relations between consultation length and content, and general practitioner choice of claiming level B or C when billing consultations > 20 minutes through Medicare., Design and Setting: A secondary analysis from a cross-sectional national general practice survey (1 April 2000 to 31 March 2003) of 101 112 consultations with 2811 GPs, comparing level B consultations 20 minutes (claimed as level B or C), and consultations > 20 minutes claimed as level C with those claimed as level B., Main Outcome Measures: Consultation length, encounter, patient characteristics; number, type of problems managed; type and frequency of treatments provided in relation to consultation level charged., Results: There were 80 476 level B consultations 20 minutes claimed as level B or C (5725 [38.4%] level B; 9168 [61.5%] level C). Longer level B+C consultations differed from shorter level B consultations in patient sex, Department of Veterans' Affairs card status, and new-patient status, and involved more reasons for encounter, problems managed, chronic problems, clinical treatments, therapeutic procedures, referrals and pathology and imaging orders. Longer consultations claimed as level C were significantly longer (0.9 minutes) than those claimed as level B and involved more reasons for encounter, problems managed (particularly new, chronic, psychosocial and gynaecological) and more clinical treatments., Conclusions: Patient characteristics and consultation content differ at longer consultations. Consultations charged as level C are more complex than those charged as level B. GPs use both time and content when choosing item number, rather than relying only on specified time thresholds. This has implications for future restructuring of MBS attendance items.

Objective: To describe the changes in bulk-billing and out-of-pocket costs for Australian general practice consultations over the period 1995-2001., Design: Retrospective analysis of 1996-2001 survey data from the Australian Longitudinal Study on Women's Health (ALSWH), linked with Medicare and Department of Veterans' Affairs (DVA) data on general practice consultations from 1995 to 2001., Participants: 22 633 women who gave consent to linkage of their ALSWH data with Medicare/DVA records. In 1996, women in the "young" cohort (n = 6219) were aged 18-23 years, those in the "mid-age" cohort (n = 8883) were aged 45-50 years, and those in the "older" cohort (n = 7531) were aged 70-75 years., Outcome Measures: Out-of-pocket costs paid by patients for general practice consultations, by calendar year, urban/rural area of residence, age, frequency of attendance, self-rated health, and education level., Results: For each age group and year studied, the use of bulk-billing was lower in rural areas than in urban areas. For example, in 2000, the percentage of women in rural and urban areas, respectively, who had all their general practice consultations bulk-billed was 31% v 52% (young women), 24% v 45% (mid-age women) and 58% v 79% (older women). There has been a steady decline in bulk-billing for general practice consultations in rural areas since 1995. The average out-of-pocket cost per consultation for women in rural areas was higher than the cost for women living in urban areas. After adjusting for age, health and socioeconomic factors, women living in urban areas were more than twice as likely to have all their consultations bulk-billed as women living in rural areas: odds ratio (OR), 2.4 (95% CI, 2.1-2.7) (young women); OR, 2.5 (95% CI, 2.3-2.8) (mid-age women); OR, 2.6 (95% CI, 2.3-2.9) (older women)., Conclusions: In Australia, the geographic differential in the cost of general practice consultations is widening. Policy changes are required to enable women in rural and remote areas to have access to affordable healthcare services.

Aim: To investigate time trends in practice activity., Design: Four cross-sectional surveys across a 15 year period., Setting: Australian private general practice., Participants: A random sample of dentists., Methods: Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998., Main Outcome Measures: Hours per year worked, patient visits per hour and patient visits per year., Results: The number of patient visits per year declined across the period, related to parallel decreases in the number of patient visits per hour (ANOVA; P<0.05), while there was no significant difference during the period in the number of hours per year devoted to work. The interaction of dentist sex by time of survey indicated that while numbers of patient visits per year had remained stable for female dentists, there was a trend for the higher number of patient visits per year among male dentists at the beginning of the survey period to decline over time., Conclusions: Male dentists had higher levels of practice activity compared with female dentists, but a decline in the number of patient visits per year reflected a convergence of male practice patterns towards that of female dentists.