Summary
This report details findings from a secondary analysis of the data collected in the BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice activity in Australia. The collection period reported is April 1999 to March 2000 inclusive. This secondary analysis was undertaken to determine the characteristics of male patients who attend general practitioners (GPs) and the characteristics of these encounters.
Method
A random sample of GPs who claimed at least 375 general practice Medicare items of service in the previous 3 months is regularly drawn from the Health Insurance Commission data by the General Practice Branch of the Department of Health and Aged Care. GPs are approached first by letter and then followed up by telephone recruitment. Each participating GP completes details about 100 consecutive patient encounters on structured paper encounter forms. The GPs also provide information about themselves and their practice.
In the 1999-00 BEACH data year a random sample of 1,047 GPs took part, providing data pertaining to 104,700 encounters. Results are reported in terms of GP and patient characteristics; patient reasons for encounter (RFEs); problems managed; medications and other treatments provided; and referrals and tests ordered. Patient-assessed health status and selected risk behaviours for subsamples of patients are also reported.
Two primary areas specific to male patients are investigated separately in this report. These are problems managed at encounters with male patients in each of the age groups 15-24, 25-34, 35-44, 45-54, 55-64, 65-74 and 75+ years; and work-related problems managed at encounters with male patients (irrespective of payment source).
The general practitioners
Males made up 69.6% of participating GPs, and those aged 45 years or older accounted for 59.1%. One in five participants was in solo practice and 26.7% had graduated in a country other than Australia. Almost one-third were Fellows of the Royal Australian College of General Practitioners (RACGP) and a further 2.2% were currently in the Training Program.
A comparison of characteristics of participating GPs with those of the GPs from the random sample who declined to participate found no significant differences between the groups with the exception of age group. Participants were significantly older and GPs aged less than 35 years were under-represented. The encounter data went through post-stratification weighting to overcome the difference and ensure that the BEACH data set was representative of Australian general practice. The weighting also incorporated the differential activity level of each GP to improve the national estimates.
The encounters
After post-stratification weighting for age (stratified by sex) and activity level, there were 104,856 encounters available for analysis. At 1,182 encounters patient sex was not recorded. There were 44,308 encounters with male patients and 59,366 encounters with female patients included in the analysis, derived from 1047 GPs. One of these GPs saw no male patients.
There were no differences between the proportion of direct (patient seen) or indirect encounters between the sexes. However, male patient encounters were less likely to be claimable through Medicare, more likely to be claimable as standard consultations and less likely to be long consultations than female patient encounters. Male patients also had significantly more encounters claimable through workers compensation than female patients.
Although there were no sex-related differences in the number of RFEs reported at the encounter, males had significantly fewer problems managed at their encounters compared with females. Males were more likely than females to have had a problem managed that was judged by the GP to be work-related. Male patients also had higher rates of procedural treatments performed and lower rates of pathology orders than their female counterparts.
The patients
Pa tient characteristics
There were significant differences in the age distribution of male and female patients at GP encounters. Males were more likely to be aged 0-14 and 45-74 years, and less likely to be aged 15-44 and 75+ years, compared with females. However, there were fewer male patients in every age group from 15 years onward. Male patients were significantly less likely than female patients to hold a health care card and more likely to hold a Veterans' Affairs gold card.
Data from the Health Insurance Commission demonstrated that a lower proportion of Australian males (76%) attended a GP at least once in 2000-01 compared with Australian females (87%). When males did attend a GP, they did so at lower rates (average 5.1 services per annum) than females (6.2 services). These differences between the sexes were most significant between the ages of 15 and 54 years and over 75 years.
Pa tient reasons for encounters (RFEs)
Male patients presented significantly more RFEs related to the respiratory and musculoskeletal systems, the skin and the ear. RFEs relating to the neurological system and the genital and urinary systems were significantly less common at encounters with male patients. When the most common RFEs were examined, they showed minimal differences between the sexes, with males more likely to describe back complaints and general check- ups and less likely to report genital check-ups, compared with females.
Problems managed
Encounters with males were significantly more likely to have one problem managed and significantly less likely to have three problems managed than were encounters with females. Problems relating to the respiratory, musculoskeletal, circulatory and digestive systems and those associated with the skin and the ear were managed significantly more often at male encounters than at female encounters. Male patients had lower rates of management of problems relating to the neurological, genital and urological systems. Back complaints, diabetes, lipid disorders and general check-ups were more commonly managed at male encounters, while depression, genital check-ups and urinary tract infections were managed significantly less often at encounters with males than at those with females.
Multiple logistic regression analyses were performed to determine which variables (i.e. predictors), independent of other predictors, were related to patient sex at the encounter. After adjustment for these significant independent predictors, the differences identified in the univariate analysis of morbidity managed were not made insignificant or reversed. In the multivariate analyses, the significant differences were replicated and additional significant differences emerged. These new significant differences in problems managed were of a general and unspecified nature, associated with the endocrine and metabolic system and related to the eye, which were managed more often at male encounters than female encounters. In contrast, social problems were managed less often at encounters with males than at those with females. Only one new significant difference in the most commonly managed morbidity emerged. Hypertension was found to be managed significantly less often at encounters with males.
Medications
Differences in the relative prescribing rate of medications types (by group, subgroup and generic name) mainly reflected differences found in the morbidities treated (Chapter 6). Males were more likely to have cardiovascular, respiratory and musculoskeletal medications prescribed and less likely to be prescribed medications from the psychological, hormone and urogenital groups. The analysis identified no differences in the prescription of generic medications between the sexes.
Other treatments
Other (non-pharmacological) treatments provided to patients were classified as either clinical or procedural. There was no overall difference between male and female encounters in the rates of clinical treatments. However, there was a specific clinical treatment (psychological counselling) that was performed less often at encounters with males than at those with females. There were significantly more procedures performed on male patients than female patients. This was reflected in the specific procedures of excision or removal of tissue (including destruction, debridement or cauterisation) and removal or repair of casts or prosthetic devices.
Referrals, tests and investigations
There were no significant differences in the overall rate of referrals or in rates of referral to specific medical specialties at male and female encounters.
The total pathology ordering rate and order rates for full blood counts, urine microscopy culture and sensitivity (MC&S) tests and thyroid function tests were significantly lower at encounters with male patients than at those with female patients.
There were no significant differences between the sexes in total ordering rates for imaging nor for any specific imaging test type.
Morbidity managed in specific male age groups
This section investigates the morbidities managed at encounters with males by ten-year age groups. In the younger age groups (15-34 years) the problems managed were mostly acute in nature, the most common being upper respiratory tract infection. Of particular interest in this age group was the relatively high rate of drug abuse managed (2.9 per 100 encounters). Heroin addiction accounted for more than 30% of these problems.
Between 35 and 44 years of age the most common problem managed was back complaint; other common problems managed were a mix of acute and chronic conditions. From 45 years onward, chronic conditions began to emerge as the most common problems managed. Hypertension was the most common condition managed in all age groups from 45 years onward.
The management of selected morbidities was also examined across age groups in this section to determine age-related changes. The management of depression showed the most interesting trend, with males aged 15-24 and 65+ years having the lowest management rates of depression despite these ages being associated with significant social life changes.
Patient wellbeing and health risk factors
- Wellbeing: Of the 12,465 male and 18,992 female respondents (aged 18+ years) less than 7% rated their health as poor. There was little difference between the sexes in self- reported health. However, male patients rated their health as 'very good' significantly less often than did female patients.
- Body mass: Responses were received from 13,062 male and 19,655 female patients aged 18 years and over. Males were less likely than females to be obese (18.1% compared with 20.0%), but more likely to be overweight (40.9% compared with 27.9%). However, when these categories were combined males were more likely than females to be overweight or obese (59.0% compared with 48.1%). Prevalence of obesity was highest in males aged between 45 and 64 years, and overweight was highest between 65 and 74 years of age.
- Smoking: There were 12,230 male and 19,930 female adults (aged 18+ years) who reported their smoking habits. Significantly more males (23.4%) than females (16.2%) smoked daily. Daily smoking was highest in males aged 18-24 years (36.7%) and declined with age.
- Alcohol use: 'At-risk' levels of alcohol intake were reported by 30.3% of the 13,076 male adult respondents and 20.1% of the 19,832 female adult respondents. Males aged between 18 and 24 years were most likely to consume alcohol at an 'at-risk' level (39.8%) and the proportion of 'at-risk' male drinkers declined with age. Of male patients who drank alcohol, 35.0% consumed alcohol at levels considered to place them at risk. Further, 47.3% of male drinkers aged between 18 and 24 years drank at risk levels.
Work-related problems managed at male encounters
Male patients had more work-related and workers compensation-funded encounters than did females. There were 2,012 male patient encounters involving problems judged by the GP to be work-related. One in ten problems managed at encounters with males aged between 25 and 44 years was found to be work-related. The most common work-related problems were back complaints, strains and sprains and other musculoskeletal injuries.
Conclusion
This secondary analysis of the BEACH data has provided the first national description of general practice encounters with male patients, their reasons for encounter, problems managed and treatment provided. The results of this study (such as male rates of GP attendance, obesity/overweight, smoking, and alcohol consumption) indicate that there is reason to be concerned about the health of males in the population, especially in the younger age groups.
There is potential to increase life expectancy and decrease death rates for Australian males by targeting their health risk behaviours, increasing their contact with GPs, and examining the social constructs which form such male behaviours. In the future, BEACH will provide a measure of the effectiveness of any strategies introduced to improve the attendance and morbidity of male patients in general practice.