GP care is low value? Think again!

The supposed "low value care" provided by GPs has been shown to be mirage. But you knew that already. Still, it's nice to have proof

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Here’s comfort for Australian GPs accused of wasting their time and public money on “low-value” care.

In September 2016, the MBS Review Taskforce Review handed down an interim report which said administrative activities by GPs, such as writing sick notes, repeat prescriptions, referrals and care plans, were seen as a drain on health dollars.

It reported that alleged waste in general practice topped the list of priority items for review in a consultation survey of more than 300 health practitioners.

In the popular media, paper-pushing GPs were blamed for a blow-out in the health budget.  The health minister of the day, Sussan Ley, fuelled the controversy by saying that the cost of GPs’ inefficiencies would be better spent elsewhere.

“If the government is paying, effectively, too much for small appointments that aren’t necessarily adding to a person’s overall health … that money does need to be reinvested,” she said.

But Sydney University researchers have drilled down into the BEACH database and concluded that the supposed waste mountain is a mirage.

Overwhelmingly, patients who visited their GP for so-called administrative reasons, such as a repeat script or a referral, walked away with a lot more, they found.

“The concept of low-value care had its inception in the United States, from where the Choosing Wisely campaign spread to many countries, including Australia,” the study authors write in the current issue of the MJA.

“We should be judicious about how we allocate health resources and minimise harm to our patients, but the role of the GP in care coordination deserves greater consideration, particularly as people in our ageing societies are living longer with chronic disease.”

The investigation found that managing chronic disease loomed large in apparently “low-value” GP visits  requested for administrative reasons.

In 2015-16, some 19% of consults began with patients seeking at least one administrative item, referrals, or medication. Potentially “low-value care-only” visits were infrequent, accounting for just 7%.

Patients asked for purely administrative work in 4% of all encounters – roughly one-third each for care planning and coordination, medical certificates and other reasons.

But GPs provided additional healthcare, including advice, counselling and education, at 70% of those visits.

“This suggests that patients are most likely to present with administrative, medication and referral requests in the context of a visit for other health needs,” the research paper says.

“Visits to GPs motivated by medication requests often resulted in the GP affording additional healthcare including managing other problems, providing education and advice, and pathology testing.

“The most common problems managed at the potentially low-care only encounters were chronic diseases, for which continuity and coordination of care are important.”

Depression was the problem most frequently managed at referral request-only visits, probably associated with GPs completing mental-health care plans, the study said.