Using Population Health Surveys to Provide Information on Access to and Use of Quality Primary Health Care

Article excerpt

Abstract

Objective: Currently, primary health care (PHC) is under-represented in health statistics due to the lack of a comprehensive PHC data collection. This research explores the utility of population health surveys to address questions relating to access to and use of PHC, using diabetes as an example.

Methods: Drawing on published material relating to diabetes management, we developed a conceptual framework of access to and use of quality PHC. Using this framework we examined three recent population-based health surveys - the 2001 National Health Survey, 2002-03 NSW Health Survey, and AusDiab - to identify relevant information collection.

Results: We identified seven domains comprising aspects of quality PHC for people with diabetes. For each domain we proposed associated indicators. In critiquing the three population health surveys in relation to these indicators, we identified strengths and weaknesses of the data collections.

Conclusion: This approach could inform the development of questions and extension of population health surveys to provide a better understanding of access to and use of quality PHC in Australia. The additional information would complement other data collections with a community-based perspective and contribute to the development of PHC policy.

Aust Health Rev 2006: 30(4): 485-495

OVER THE PAST TWENTY YEARS there has been a radical shift in the way in which health care services are provided. This is reflected in shorter hospital stays, increases in day-only procedures, and increased management in community settings of conditions that previously would be considered acute health problems requiring hospitalisation. Investment in these community-based settings has been estimated at between 30%-40% of all health expenditure.1 Despite this, Australia does not have a comprehensive data collection on access to or use of primary health care (PHC) services, and thus PHC services are under-represented in health statistics.2 By PHC, we refer to those health-related services provided in community-based settings through general practice, allied health and nursing services (publicly and privately funded) and community health services (generally funded by state governments and the non-government sector). The reasons for the lack of a comprehensive PHC data collection lie in the complex mix of Commonwealth and state, publicly and privately funded services, as well as the range of services that are provided.

While a variety of population health data collections provide some information on access to and use of PHC, services that have limited public funding are not captured in these data collections. The Health Insurance Commission (HIC) collates information on claims for reimbursement for medical care, diagnostic services and pharmaceutical products. Due to regulatory and financial considerations, these are incomplete. For example, prescriptions that cost less than patient copayments will not appear in the data collection; and similarly, many medical services are not identified.2 In addition, specific patient information such as diagnosis, reason for the service, and treatment provided are not collected.2 To address the gap in general practice data, the Bettering the Evaluation and Care of Health (BEACH) program was developed as a cross-sectional paper-based survey of GP activity, collecting information on patients and their treatment in the GP setting.3 BEACH provides a snapshot of general practice activity, but not a comprehensive overview of patterns of access to and use of PHC services, or quality or outcomes of care. Except locally, information on allied health and nursing services in either the private or public sectors is not systematically collected.4 Hospital admissions for ambulatory care-sensitive conditions, that is, conditions that should not present to hospital services if adequate care is provided in the PHC setting, have also been used as proxy measures of PHC activity. …