The National Health Survey 2001: Usefulness to Inform a Discussion on Access to and Use of Quality Primary Health Care Using Type 2 Diabetes Mellitus as an Example

Article excerpt

Abstract

Introduction: This paper explores the usefulness of the 2001 Australian Bureau of Statistics National Health Survey (2001 NHS) for examining access to and use of quality primary health care (PHC) in Australia, using diabetes as an example.

Methods: Potential indicators of access to and use of quality diabetes care were investigated (diagnosis, preventive pharmacotherapy, complication screening, multidisciplinary care and hospitalisation), and their association with various factors including socioeconomic and diabetes-related health status was assessed.

Results: Older Australian-born females were more likely to receive preventive pharmacotherapy, whereas complication screening was associated with duration of disease. Multidisciplinary care was associated with recent hospitalisation and not health need assessed by presence of comorbidity.

Conclusions: This novel use of the 2001 NHS provided information on patterns of access to and use of diabetes-related PHC that were consistent with previous research. It suggests a new role for survey data in monitoring access to and use of PHC over time and complementing other population health data collections in this area.

Aust Health Rev 2006: 30(4): 496-506

IN A PREVIOUS PAPER we proposed a conceptual framework for examining access to and use of quality primary health care (PHC) using population health surveys, and with type 2 diabetes as an example.1 This enabled us to draw on extensive research evidence, published management guidelines, and the 2005 National Diabetes Strategy Indicator Project to propose a number of domains of care that could be implemented in the PHC setting.2-6 These domains are considered to be consistent with quality care for people with diabetes. Using this approach and despite the limitations of the information that is currently sought, we identified potential indicators of access to and use of quality PHC that were available in the 2001 National Health Survey (2001 NHS) data.7 The aim of this paper is to present an analysis of these data to explore the utility of this approach. Firstly, we describe the prevalence of type 2 diabetes mellitus and its risk factors, and examine factors associated with increased prevalence. Next we examine indicators of socioeconomic differentials reported by participants; and, finally, we examine those social determinants that are associated with our proposed indicators of access to quality PHC.

Methods

The 2001 NHS was an Australian population-based survey comprising one randomly selected adult from each of 17 918 private dwellings using multistage area sampling techniques.7 Our analyses include only participants aged 45 years or more. Participants responses to two specific questions (Have you ever been told by a doctor or nurse that you have: diabetes? or high sugar levels in your blood or urine? or neither? What type of diabetes were you told you have?) were used to identify participants with type 2 diabetes mellitus.

The 2001 NHS assessed five of seven proposed domains of access to "quality" PHC for people with diabetes:

* Detection of diabetes and risk factors for diabetes: based on self-report of diabetes or of risk factors (obesity and physical inactivity)

* Proactive PHC: self-report of anti-hypertensive or lipid-lowering medication use (preventive pharmacotherapy)

* Complication screening: self-report of an eye check in the last 2 years

* Multidisciplinary care: self-report of seeing a general practitioner and a dietitian, podiatrist, or nurse during the last 2 weeks.

* Hospitalisation: based on self-report of hospitalisation during the last 12 months.

The first of these domains is used to calculate prevalence in the total sample. Data for the remaining domains, presented for those participants reporting diabetes, are regarded as potential indicators of access to and use of quality PHC. Two domains (prevention of diabetes and monitoring of symptom control) are not included in this paper. …