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3.17 Regular GP or health service

Why is it important?

Having a usual primary health care provider is associated with good communication between the patient and provider, greater levels of trust and satisfaction with providers (Mainous et al. 2001; Schers et al. 2005), and better health outcomes for patients (Starfield 1998; Starfield et al. 2004). Those with a usual primary care provider are more likely to receive: care based on guidelines, preventative care, and better coordination of care with other providers to meet patient need (Forrest et al. 1996; Atlas et al. 2009). Other benefits of having a continuous doctor–patient relationship include improved diagnoses, better medication management, avoidance of repeat tests or other interventions, and fewer hospitalisations, particularly for people with complex health care needs (Hollander et al. 2009).

Findings

Based on self-reported data from the 2012–13 Health Survey, 86% of Aboriginal and Torres Strait Islander peoples have a usual place to go for health problems and advice. Most Aboriginal and Torres Strait Islander peoples usually went to a doctor if they had a problem with their health (54%) followed by Aboriginal Medical Services (AMS) (17%), community clinics (10%) and hospitals (5%). Note: some caution is needed as respondents may not clearly differentiate between an AMS and a community clinic (ABS 2013b) or between a doctor at an AMS or another practice (i.e. it is estimated that 3% of those that usually went to a 'doctor' went to an AMS doctor). In 2012–13, 14% of Indigenous Australians had no regular source of health care. Use of AMS and community clinics increased by remoteness, from 13% in major cities to 66% in very remote areas.

The survey asked where people would like to go if they were sick or needed advice about their health. In 2012–13, 53% of Indigenous Australians reported they would prefer to go to a doctor, 26% to an AMS, and 9% to a community clinic. In most instances Indigenous Australians expressed a preference for the services they currently use and services available in their local area. Preferences varied by remoteness with GPs preferred mostly by Indigenous Australians in major cities (68% compared with 10% in very remote areas) and community clinics preferred mostly by Indigenous Australians in very remote areas (50% compared with 2% in major cities). Nationally, 27% of Indigenous Australians who said they would like to go to an AMS did not have an AMS available in their local area.

Availability of services varied across Australia. Around 95% of those living in major cities reported GPs being available compared with 31% in very remote areas. AMS were reported as being locally available by 61% of those living in outer regional areas and 26% of those in very remote areas. In 2012–13, 77% of Indigenous Australians living in very remote areas reported that there were community clinics available compared with 33% of those living in major cities.

Nationally, 5% of Aboriginal and Torres Strait Islander peoples usually go to hospital if there is a problem with their health. See measure 3.07 for analysis of hospitalisations for conditions that could be prevented if primary health care services were better able to meet the needs of Aboriginal and Torres Strait Islander peoples. A higher use of hospitals for regular health care was reported in WA and Qld (both 10%) than in other jurisdictions (1%–3%).

In the 2012–13 Health Survey, 16% of Indigenous Australians reported being treated badly in the previous 12 months because they are Aboriginal or Torres Strait Islander. Of those, 20% reported being treated unfairly by doctors, nurses or other staff in hospitals or doctors' surgeries. About 7% of Indigenous Australians reported that they had avoided seeking health care because they had been treated unfairly. Further analysis of this issue is discussed in the context of cultural competency (see measure 3.08).

In the same period, 70% of Aboriginal and Torres Strait Islander peoples rated their health care experience as 'excellent' or 'very good' in the previous 12 months. The majority of Indigenous Australians aged 15 years and over living in non-remote areas reported that doctors listened to them (89%), explained things in a way that could be understood (87%), showed respect for what was said (89%) and spent enough time with them (85%). The 2012–13 Patient Experience Survey provides comparable data for the total Australian population: GP listened (89%), showed respect (93%) and spent enough time (88%) (SCRGSP 2013). Indigenous Australians with no usual GP/medical service reported lower rates of satisfaction than those with a regular doctor/GP (61% reporting excellent or very good compared with 73%).

In the 2008 Social Survey, 80% of Indigenous Australians aged 15 years and over agreed that their doctor can be trusted.

Implications

Most Aboriginal and Torres Strait Islander peoples have a usual source of health care. This finding is encouraging as access to a usual source of care is one of the foundations for a good primary health care system. The main sources of primary health care for Indigenous Australians are GPs, AMSs and community clinics. While mainstream general practice is a significant source of care for Indigenous Australians, for most GPs, Indigenous clients will remain a small proportion of their clients. Some mainstream practices have implemented strategies explicitly focused on their Indigenous patients (Hayman et al. 2009; Spurling et al. 2009).

Australian Government initiatives include the Practice Incentives Programme—Indigenous Health Incentive (PIP–IHI) to support general practices and Indigenous health services to provide better health care for Aboriginal and Torres Strait Islander patients. Payments are made to practices that register for the PIP–IHI and meet certain requirements, including establishing and using a mechanism to ensure Indigenous patients aged 15 years and over with a chronic disease are followed up (e.g. use of a recall/reminder system or staff actively seeking out patients to ensure they return for ongoing care), and at least two staff members from the practice (one of whom must be a GP) completing appropriate cultural awareness training. In 2013–14, about 3,500 general practices and Indigenous health services had signed on to the incentive. Around 56,000 patients were registered in 2013 (Department of Health unpublished).

The Australian Government will boost GP training places by 300 (from 1,200 to 1,500 new places) in 2015. As many of these places as possible will be in regional and rural Australia.

Figure 3.17-1 Usual source of health care by type, Indigneous Australians, by remoteness, 2012–13
chart showing Usual source of health care

Figure 3.17-1 shows the proportion of types of usual sources of health care (including no usual source of care) for Aboriginal and Torres Strait Islander peoples in 2012–13. Data presented for: doctor/GP, Aboriginal medical service, community clinic, hospital and other (which includes traditional healer). Data presented separately for major cities; inner regional areas; outer regional areas; remote areas; very remote areas; and Australia. In 2012–13, 87% of Indigenous Australians had a usual place to go for health problems and advice. Most (54%) went to a doctor, 17% to an AMS, 10% to a community clinic and 5% to a hospital. Nearly 14% had no usual source of care.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 3.17-2 Preferred source of health care by type, Indigneous Australians, by remoteness, 2012–13
chart showing Preferred source of health care

Figure 3.17-2 shows the proportion of preferred sources of health care for Aboriginal and Torres Strait Islander people in 2012–13. Health care types include: doctor/GP, Aboriginal medical service, community clinic, hospital and other (which includes Traditional Healer). Data presented separately for major cities; inner regional areas; outer regional areas; remote areas; very remote areas; and Australia. In most instances respondents expressed a preference for the services they currently use. Preferences varied by remoteness with the highest rates in major cities for GPs (68% compared with 10% in very remote areas) and highest rates for community clinics in very remote areas (50% compared to 2% in major cities).

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 3.17-3 Available sources of health care by type, Indigenous Australians, by remoteness, 2012–13
chart showing Available sources of health care

Figure 3.17-3 shows the sources of health care reported as being available by Aboriginal and Torres Strait Islander people in 2012–13. Data is presented for the following types of health care: doctor/GP, Aboriginal medical service, community clinic, hospital and other. Data is presented separately for major cities; inner regional areas; outer regional areas; remote areas; very remote areas; and Australia overall. Availability of services varied across Australia. Around 95% of those living in major cities reported GPs being available compared with 31% in very remote areas. AMS were reported as being locally available by 61% of those living in outer regional areas and 26% of those in very remote areas. Most Indigenous Australians living in very remote areas (77%) reported that there were community clinics available compared with 33% of those living in major cities.

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 3.17-4 Patient experience by usual source of healthcare, Indigenous Australians aged 15 years and over who saw a doctor or specialist (non-remote) 2012–13
chart showing Patient experience by usual source of healthcare

Figure 3.17-4: shows the proportion of Indigenous Australians reporting measures of patient experience by usual source of health care in 2012–13. Data is presented for the following regular types of health care: doctor/GP, Aboriginal medical service/community clinic, hospital, no usual provider, and other. Data is presented separately for each of the following measures of patient experience: felt listened to; felt things were explained; felt respected; felt enough time was spent with them; and overall rating of excellent/very good. ). Indigenous Australians with no usual GP/medical service reported lower rates of satisfaction. The majority of Indigenous respondents reported that doctors listened to them, explained things in a way that could be understood, showed respect for what was said, and spent enough time with them.

Source: ABS and AIHW analysis of 2012–13 AATSIHS