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.
It is intended to compare data across practice these types and between the present study and the Waikato Primary Medical Care Survey (WaiMedCa) carried out in 1991/92.
This paper provides a descriptive report on the week-day, day-time content of the work of private general practitioners (GPs). No statistical tests are applied. Other papers will report on after-hours activities and on other types of practice, and will analyse differences in practice content that have occurred over time or that exist between practice settings.
A nationally representative, multi-stage sample of private 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.
Medical practitioners in general 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.
Data were contributed by 199 private GPs, they logged 36,211 visits and provided detailed information on 8258.
The characteristics of the patients were:
- Attendance rates were higher among those below five years, and women over age 55 and men over age 65.
- Almost half the sample was eligible for a Community Services Card or a High User Health Card.
- About 5% of the sample had poor social support and a similar number were not fluent in English.
Details of the consultations included:
- The great majority of visits (88.3%) were standard medical visits financed by the patient, with or without general medical benefit subsidisation. There was little variation in rates across practice types.
- ACC claims were made at 9.4% of visits; maternity visits made up 2.3%
- Mean visit duration was about 15 minutes.
- Rapport was low in 1.3% of visits and the GP was uncertain of the appropriate action to take in 2.8%.
- GP and patient were unknown to each other in 12% of consultations.
Problems presented had the following features:
- Problems were judged urgent in 37.7% of visits.
- Urgency was related to youth and to residence in a deprived area.
- Problems were judged life-threatening in 2% of cases and the rate increased with age; the problem was self limiting in 34% of cases (that is, the problem would have gotten better by itself, without medical intervention)
- On average 1.4 reasons-for-visit were recorded; in 45% the problem was already diagnosed; in 5.8% a preventive activity was planned.
- On average 1.6 problems were recorded; 49% were new or short term.
- Respiratory was the commonest type of problem presented.
Management activities noted were:
- Investigations were ordered at 25% of visits; most were laboratory tests.
- Visits resulted in emergency referral in 1.3% of cases, other medical or surgical referral in 8%, and in a specific follow-up appointment in 57%.
- Drugs were prescribed at 66% of visits with an average of 129 items per 100 visits; the number of items, but not of prescriptions, increased with age.
- The commonest group of drugs were those affecting the respiratory system.
- Non-drug management was recorded at 62% of visits; the commonest item was health advice and this was given more frequently to females.
- In the parameters examined there are only minor differences between practice types.
Conclusions and implications
No statistical tests have been applied in this report and only impressions can be drawn. There is little evidence that practice type systematically affects practice content or activities. More detailed analyses will show whether suggestive differences in treatment and referral patterns are of substantive importance. It would appear that capitated funding alone is insufficient to induce a move towards medical delegation or increase preventive activity.