Summary
Aims
The National Primary Medical Care Survey was undertaken to describe primary health care in New Zealand, including the characteristics of providers and their practices, the patients they see, the problems presented and the management offered. The study covered private general practices (ie, family doctors), community-governed organisations, and Accident and Medical (A&M) clinics and Emergency Departments. It was intended to compare data across practice types as well as over time. Subsidiary aims included gathering information on the activities of nurses in primary health care, trialling an electronic data collection tool and developing coding software.
This report describes the characteristics of practitioners, patients and patient visits for general practices located in rural areas – defined as those practices with a rural ranking score equal to or greater than 35. This is the criterion for eligibility for Ministry of Health rural health benefits. The characteristics of these practices are compared to those of all others, called “non-rural” in this report. Other reports in the series describe private family doctors, Māori doctors, and after-hours activities and other types of practice, and will analyse differences in practice content that have occurred over time or that exist between practice settings.
Methods
A nationally representative, multi-stage sample of private general practitioners (GPs), stratified by place and practice type, was drawn. Each GP was asked to provide data on themselves and on their practice, and to report on a 25% sample of patients in each of two week-long periods. Over the same period, all community-governed primary health care practices in New Zealand were invited to participate, as were a 50% random sample of all A&M clinics, and four representative Hospital Emergency Departments.
Rural location was defined according to a scale allocating points according to the following Ministry of Health criteria:
- frequency of on-call responsibilities
- requirement to be on-call for major trauma
- occurrence of regular peripheral clinics
- travel times to nearest hospital, nearest colleague, and the most distant boundary.
Medical practitioners in general practices, community-governed non-profit practices, and A&M clinics completed questionnaires, as did the nurses associated with them. Patient and visit data were recorded on a purpose-designed form.
Results
Data for this report were contributed by 47 rural GPs and 197 urban doctors. There were 8686 visits logged and 1957 patient encounters at the rural practices, with 31,991 logged visits and 7315 patient encounters recorded at non-rural practices.
The findings included the following:
- Rural practitioners were predominantly male and aged 35–44 years. More had graduated overseas than their urban counterparts, and their practices were smaller, but with greater throughput.
- While the age and gender profile of patients was similar across practice locale, rural providers had more patients from deprived areas and with a Community Services Card, more Māori (and European), but fewer judged to have language difficulties.
- The visiting profile of patients was the same – that is, the proportion new to the practice, number of previous visits, payment source, pattern of severity – but consultation length was slightly longer in rural practices and patients presented slightly fewer problems and reasons for visit.
- In general, patients presented much the same types of problems across practice locale, but rural GPs tended to order fewer tests and investigations than their urban counterparts. Furthermore, patients at non-rural practices tended to receive more treatments and treatment items. Similarly, there was a slightly lower rate of follow-up at rural practices (although similar rates of referral).
- In comparing practice characteristics by locale, there were fewer full-time equivalent practice nurses in rural settings and practice fees were lower, but more services provided, such as evening surgery, group health promotion and doctors involved in maternity care. Rural practice nurses also seemed to offer a slightly greater range of services.
Conclusions
The National Primary Medical Care survey has provided the most comprehensive and representative sampling of the character of rural and non-rural practice in New Zealand. Although the study has not been able to generate important information on work outside standard office hours (which could be more substantial in rural areas), its findings – as outlined above – bear a close similarity to earlier studies in New Zealand and comparable investigations overseas. Overall, the impression is of a very similar pattern of presentation of patient problems across locale. Yet it also appears that rural providers have a higher workload and smaller practices, and generally allocated slightly fewer services (such as tests and investigations, treatments and treatment items, and follow-up). While these differences are not large, they do raise matters of potential policy interest in maintaining a viable rural primary health care system in New Zealand.
Disclaimer
The views expressed in this occasional paper are the personal views of the authors and should not be taken to represent the views or policy of the Ministry of Health or the Government. Although all reasonable steps have been taken to ensure the accuracy of the information, no responsibility is accepted for the reliance by any person on any information contained in this occasional paper, nor for any error in or omission from the occasional paper.