Inter-Practice Variability in General Practice Consultations With Older Patients: A Cross-Sectional Analysis of the Registrar Clinical Encounters in Training Study

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-06-10 DOI:10.1111/jep.70139

Adele Kincses, Alexandria Turner, Alison Fielding, Amanda Tapley, Andrew Davey, Dominica Moad, Elizabeth Holliday, Jason Dizon, Mieke van Driel, Parker Magin

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引用次数: 0

Abstract

Rationale

General practice is central to older patient care provision. For GP registrars (specialist GPs in training), exposure to older patients is also vital for developing chronic disease and multimorbidity management skills. However, registrars see fewer older patients, and are less engaged with older patient care, than established GPs.

Aims and Objectives

This study aimed to assess inter-practice variability in the proportion of older patients seen by Australian GP registrars during training.

Method

Cross-sectional analysis from the ReCEnT study of GP registrars' clinical experiences (2010–2023). The outcome was consultation with older (65+ years) patients. Inter-practice variability was assessed with Intraclass Correlation Coefficient (ICC) and Median Odds Ratio (MOR). Outcome variance attributable to practice was estimated within the Bayesian modelling framework using a mixed-effects logistic regression with cross-classified random effects for registrar and practice.

Results

The analysis included 4643 registrars across 978 practices. 19% (129,659/688,281) of consultations were with older patients. The ICC was 0.15 (95% Credible Interval (CrI) [0.14, 0.17]) in a model with a random effect for practice; and, in a model adjusted for time/registrar/patient/practice variables, 0.10 (CrI [0.09, 0.11]). These values (comparable with, or higher than, reported for other general practice variables), indicate registrars' older patient clinical exposure is dependent upon the practice(s) trained in. The MOR was 2.08 (CrI [(2.00, 2.16]); and, adjusted, 1.81 (CrI [1.76, 1.87). By randomly changing practice location, the odds of a registrar's consultation being with an older patient thus approximately doubles (or, alternatively, halves) on average.

Conclusion

The practice itself is the greatest determinant in registrars' exposure to older patients. Practice-level interventions are essential to improve registrars' in-training older patient care experience.

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老年患者全科门诊会诊的跨实践变异性：培训研究中注册医师临床遭遇的横断面分析

基本原理：一般实践是老年患者护理提供的核心。对于全科医生登记员（培训中的专科全科医生）来说，接触老年患者对于发展慢性疾病和多种疾病管理技能也至关重要。然而，与现有的全科医生相比，注册医生看到的老年患者较少，对老年患者护理的参与度也较低。目的和目的本研究旨在评估澳大利亚全科医生在培训期间看到的老年患者比例的执业间变异性。方法对2010-2023年全科医生登记员临床经验进行横断面分析。结果是老年（65岁以上）患者的咨询。采用类内相关系数（ICC）和中位优势比（MOR）评估实践间变异性。在贝叶斯模型框架内，使用混合效应逻辑回归对注册者和实践的交叉分类随机效应估计归因于实践的结果方差。结果分析包括978个实践中的4643个注册商。19%（129,659/688,281）为老年患者。在实践随机效应模型中，ICC为0.15(95%可信区间（CrI） [0.14, 0.17])；在调整时间/注册/患者/实践变量的模型中，为0.10 （CrI[0.09, 0.11]）。这些值（与其他全科医学变量报告的值相当或高于其他全科医学变量报告的值）表明，登记员的老年患者临床暴露程度取决于所培训的医学实践。MOR为2.08 (CrI [(2.00, 2.16])；调整后为1.81 （CrI[1.76, 1.87]）。通过随机改变执业地点，注册医生会诊老年患者的几率因此平均约为两倍（或一半）。结论执业本身是挂号员接触老年患者的最大决定因素。实践层面的干预措施对于改善注册人员在职老年患者护理经验至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.