Data, data, everywhere – but not a drop on general practice.
Numbers can tell a powerful story about general practice, but – for better or for worse – there’s nothing happening until robust data collection processes are funded, according to the AMA.
As the AMA pointed out in its submission to the Treasury’s Measuring What Matters statement, the economic impact of inadequate prevention and delayed treatment can snowball over a person’s lifetime, creating ripples that reach beyond the health system.
“Delaying a minor surgical intervention to improve the hearing of a child can result in significant challenges later in life if they miss crucial developmental milestones,” the association said.
“This is likely to incur much larger costs throughout their life than the cost of surgery.”
It went on to recommend that future investment in health should focus on preventative care, thus increasing the working population by reducing the number of years people spend living chronic disease or illness.
One of its key recommendations to verify the savings made by general practice through longitudinal preventative care was to restart the Bettering the Evaluation and Care of Health program, better known as BEACH.
The 18-year-long project collected data on almost 1.8 million GP-patient interactions and formed the basis of several hundred publications and grant applications.
But collecting data on general practice is somewhat of double-edged sword.
On one hand, data quantifies what goes on in general practice, creating a convincing argument for increased resources and funding at both state and federal levels.
In systems like the UK’s National Health Service though, around 10% of GP practice funding is directly tied to the practice’s performance against a set of indicators.
While the use of data isn’t by any means the only part of the NHS that frustrates British GPs, bureaucracy and a sense of being micro-managed under a capitation system is an oft-cited reason for primary care doctors leaving the system.
NSW-based GP academic Professor Charlotte Hespe told TMR that part of the UK problem stems from the fact that the data has become the driver of GP behaviour, rather than the other way around.
“There is no reason at all for [Australia] to end up with a system like that, because we’ve got [the UK] to learn from,” she said.
“If you’re doing true quality improvement, you … make it so that we can use the data to actually improve what we do.”
Preventative care, due to its intangible nature, is already a hard sell.
“It’s not very sexy to be told that I’m preventing your heart attack in 10 years’ time,” Professor Hespe said.
“You’re likely much more interested in being able to get out and have a good time and party and, you know, eat chocolate cake and drink a couple of bottles of wine.”
In layman’s terms, it’s hard for GPs to concretely demonstrate that patients are avoiding a certain outcome over a long period of time.
In terms of value propositions, driving an ambulance to the bottom of the cliff if someone happens to fall has a more immediate, tangible impact than investing in a fence for the top of the cliff.
It’s even harder to use the data that comes from preventative to design a system that rewards doctors for outcomes instead of activities.
“If the outcomes we measure are our activity, then we are really not measuring outcomes at all,” NSW GP Dr Kean-Seng Lim told TMR.
“And at the other end, what’s really important, apart from measuring outcomes … is actually making sure we have holistic view of the outcomes we need to measure rather than looking at limited subsets of outcomes.”
Dr Lim, whose Western Sydney practice is renowned for its innovative use of data, said that moving away from rewarding activities alone allows practices to get creative and meet individual patient needs through different means, like group sessions, remote monitoring or asynchronous consults.
“Even though we have countries [like the UK] which talk about outcomes-based frameworks, they’re often actually … activity-based,” he said.
“As an example … if we were to use some of the measures we’ve got, such as measuring the …. percentage of patients with type two diabetes who’ve had their blood tests measured in the last 12 months, that’s really an activity-based measure.
“Whereas what we really want to know is how many are under control and how many might require further treatment.”
The AMA submission to the Treasury has come amid renewed calls for a revamped BEACH program from the RACGP.
In its submission to the Health Technology Assessment Policy and Methods Review earlier in the month, the college also called for further investment in technology to capture and analyse primary care data for post-market surveillance.
