BMJ  2007;334:1261 (16 June), doi:10.1136/bmj.39203.658970.55 (published 15 May 2007)

Research

Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from three national surveys

¹ Division of General Internal Medicine, University of California San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA , ² Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Abramson 1335, Philadelphia, PA 19104, USA, ³ Australian GP Statistics and Classification Centre, University of Sydney, Westmead Hospital, 2145 NSW, Australia, ⁴ University of Otago, Department of Public Health, Wellington School of Medicine and Health Sciences, PO Box 7343, Wellington, New Zealand, ⁵ Department of Primary Care and Social Medicine, Imperial College London, London

Objectives To compare mix of patients, scope of practice, and duration of visit in primary care physicians in Australia, New Zealand, and the United States.

Design Comparison of three comparable cross sectional surveys performed in 2001-2. Physicians completed a questionnaire on patients' demographics, diagnoses, and duration of visit.

Setting Primary care practice.

Participants 79 790 office visits in Australia, 10 064 in New Zealand, and 25 838 in the US.

Main outcome measures Diagnostic codes were mapped to the Johns Hopkins expanded diagnostic clusters. Scope of practice was defined as the number of expanded diagnostic clusters accounting for 75% of all managed problems related to morbidity. Exposure to primary care was calculated from duration of visits recorded by the physician, and reports on rates of visits to primary care for each country.

Results In each country, primary care physicians managed an average of 1.4 morbidity related problems per visit. In the US, 46 expanded diagnostic clusters accounted for 75% of problems managed compared with 52 in Australia, and 57 in New Zealand. Correlations in the frequencies of managed health problems between countries were high (0.87-0.97 for pairwise comparisons). Though primary care visits were longer in the US than in New Zealand and Australia, the per capita annual exposure to primary care physicians in the US (29.7 minutes) was about half of that in New Zealand (55.5 minutes) and about a third of that in Australia (83.4 minutes) because of higher rates of visits to primary care in these countries.

Conclusions Despite differences in the supply and financing of primary care across countries, many aspects of the clinical practice of primary care physicians are remarkably similar in Australia, New Zealand, and the US.

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Important issues unaddressed

Dr. Harsha Kumar H N
bmj.com, 16 May 2007 [Full text]