- Jennifer Welsh, Rachel Freeman-Robinson, Danielle C. Butler, Rachael Eddowes, Amelia Yazidjoglou, Angus Douglas, Kirsty A. Douglas, Nina Lazarevic, Hsei-Di Law, Grace Joshy, Susan Trevenar, Tsheten Tsheten, Adrian Webster, Michael Frost, Bernice Cropper, Sally Hall Dykgraaf, Christine B. Phillips, Emily Banks
- Rosemary J. Korda
Correspondence: jennifer.welsh@anu.edu.au
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Abstract
Objective
To quantify continuity of care in general practice in the Australian population, including variation according to patient characteristics and over time, to support ongoing policy reforms directed towards improving general practice care.
Design and Setting
Repeated cross-sectional analyses of linked whole-of-population data from the Medicare Benefits Schedule, the Medicare Consumer Directory and the Census of Population and Housing (2021).
Participants
Continuity was assessed in people with at least four general practitioner visits in a 2-year period (about 80% of the population).
Main Outcome Measure
Relational continuity of care in general practice, measured with the Usual Provider Index, for eight overlapping 2-year periods (2016–2017 to 2022–2023). High continuity was defined as having ≥ 70% of visits with one provider.
Results
About one-third of the population had high continuity of care (range: 31.3% in 2018–2019 to 37.2% in 2020–2021). After adjustment for age, sex and remoteness, high continuity was more common among those with greater care needs, including those who were older (≥ 70 years vs. 0–14 years: adjusted prevalence ratio [aPR], 1.88) or with health conditions (e.g., ≥ 3 vs. none: aPR, 1.14) and those who were living in more disadvantaged areas (e.g., most vs. least disadvantaged: aPR, 1.22), born overseas (e.g., born in Southern or Eastern Europe vs. born in Australia or New Zealand: aPR, 1.20) or not proficient in English (aPR, 1.29). However, it was less common for females compared with males (aPR, 0.90) and those living remotely (e.g., very remote vs. major cities: aPR, 0.43).
Conclusion
While most people in Australia do not receive continuous care in general practice with a specific provider, those with greater healthcare needs are more likely to. With ongoing policy reforms, monitoring continuity of care may provide insights into the consequences for quality of care.