Matching care to need in general practice: A secondary analysis of Bettering the Evaluation and Care of Health (BEACH) data

Abstract

Addressing health inequality involves, in part, ensuring access to quality general practice care appropriate to the higher health need in patients from disadvantaged areas. This study compares characteristics of encounters in Australian general practice with patients of high and low socioeconomic disadvantage. The method used was an analysis of data from the study of Australian general practice morbidity - the Bettering the Evaluation and Care of Health, April 1998-March 2001 - comparing patients whose residence was in either the highest or lowest category of socio-economic disadvantage based on the Socio-Economic Indexes for Areas Index of Relative Socio-economic Disadvantage. Multiple regression investigates independent predictors of low and high socio-economic disadvantage. Encounters with patients from areas of highest disadvantage differed markedly in the problems managed from those with patients from areas of least disadvantage. However, psychosocial problems were managed at the same rate in each group. Encounters with patients from areas of highest disadvantage were more likely to be with males, patients from non-English speaking or Indigenous backgrounds, in rural areas, and result in a prescription. They were less likely to be a long consultation, with a female GP, or to result in investigation or referral. The differences in care between the two groups of patient encounters cannot be explained by differences in morbidity. More research is needed to explain why these differences occur, including the possible influence of patient, provider and practice factors. General practitioners working with patients from disadvantaged communities may need greater support to deliver optimal quality of care.