How Australians rate chronic health management

The Australian

7 hours ago

By modern measures, Lesley Hoatson just might be a medical unicorn.
In the past 40 years, she has been treated by only two general practitioners. Even then, she only switched doctors because one retired.
She attributes it to her local clinic's knack for retaining staff.
'I think it's because the practice I go to is a community health centre and to work there you probably have to be pretty committed to that sort of service to the community,' she says.
Ms Hoatson, 74, looks the picture of health. She leads an active lifestyle and is preparing to hike through the French Alps. She is also a frequent gym-goer, enjoys pilates and regularly volunteers in her local community.
But what might not be as obvious is that, like half of all Australians aged over 65, Hoatson lives with multiple chronic health conditions. She has high blood pressure, high cholesterol and anxiety, all of which she says are managed effectively with the help of medication and a trip to the GP every six months.
'He monitors those medications each time I go, and that's fairly straightforward,' she says.
Ms Hoatson feels her GP includes her in all conversations about her health and talks through her treatment options, and lets her decide the course of action. He supports whatever decision she makes. She says it is a relationship built around trust and respect, and that has filled her with confidence in the health system.
'Without him sort of breathing down my neck, I feel comfortable about having made decisions and managing what I'm doing with my own health,' she says.
'I've never known any different. Maybe it's a little bit of luck. I think if you were swapping to a different doctor every time, it would be a much more basic exchange of what's happening and that's it.
'Whereas this is actually about you, the person, and you should feel like (the doctor) is actually interested in you. Even though my doctor has a short amount of time to see me, he does it efficiently, and I come away feeling like I have been heard and he has responded to what I needed.'
Ms Hoatson has documented her experience as part of the international Patient-Reported Indicator Survey. The survey focuses exclusively on the experiences of patients in primary care and compares how 19 OECD member nations perform.
More than 100,000 patients who live with chronic illness took part globally, including 2392 from Australia.
Respondents were patients aged 45 and over, had at least one chronic condition, and visited a GP in the six months prior to the survey. They were asked about their experience, outcomes, and how they accessed health information and services.
Associate Professor Liz Marles is a spokeswoman for the Australian Commission on Safety and Quality in Health Care, which conducted the study on behalf of the Health Department. She is also a former president of the Royal Australian College of General Practitioners and says Australia held its own, performing better than or close to the OECD average across 10 health measures, and ranking in the top five in quality of care, co-ordination of care, person-centred care and physical health.
However, there were three areas to improve, especially in mental health, wellbeing and social functioning – which considers how well someone can perform everyday activities and responsibilities.
'What we're looking at here is how people with chronic conditions, what their experience is in terms of healthcare delivery,' Dr Marles says.
'It's that in-depth perspective that allows us to see how well we're performing and probably gives us much greater insight, really, into what are the strengths in the system and what are the areas that we probably need to focus on.'
One key finding was that patients with greater continuity of care had better outcomes than those without, and those who maintained the same GP had a greater level of trust in the system.
'As a GP, I know when I see a person that I'm familiar with, it's just a much easier consult,' Dr Marles says.
'I already know what their preferences are, so whether they're someone who is very anxious about their health and wants to have lots of investigations, or whether they're someone who maybe doesn't pay enough attention to their health, and I need to be a bit more proactive with that person.
'Knowing a person's preferences really helps, and that's what person-centred care is. And we rated really highly on person-centred care; Australia was 94 per cent versus 85 per cent for the OECD average.'
The results further highlight the postcode lottery and other health inequalities, with patients in cities and those with higher levels of education and income reporting better experiences, which then led to improved health outcomes.
David Fong is a general practitioner at Co Health, a multidisciplinary community health centre in the Melbourne suburb of Kensington. The clinic works closely with allied health professionals and was one of dozens nationally that had patients participate in the survey.
A lot of Dr Fong's patients are from non-English-speaking backgrounds and include refugees, concession card holders and pensioners. Not all of them are familiar with how to navigate Australia's health system, which could lead to confusion and distrust if not managed appropriately.
He says managing chronic conditions requires careful planning.
'Many patients do recognise the value of seeing the same doctor or the same clinicians, or nurses they're familiar with as well, who have learned this story,' he says.
'But it's also a supply problem … sometimes one particular doctor is not available. For chronic conditions, though, if you plan ahead you can always see your doctor, you just might have to wait.'
Australia has a high burden of chronic disease, which is growing as the population ages. It's a trend that adds pressure to the broader health system, care providers and the community.
According to the Australian Commission on Safety and Quality in Health Care, in 2022, half of Australians had at least one chronic condition, and in that year alone $82bn was spent on treating chronic disease.
'Chronic conditions were recorded as an underlying or associated cause of 90 per cent of all deaths, and were responsible for 91 per cent of the non-fatal burden of disease,' the report states.
Further, chronic conditions represent the fastest-growing segment of healthcare users in Australia. The most common chronic condition reported in this country was high blood pressure, followed by arthritis or joint pain, depression or other mood disorder, breathing conditions, and cardiovascular or other heart conditions.
The survey found patients with multiple chronic conditions were less confident of managing their own care but also had less trust in the health system and doctors.
People living with chronic conditions including liver disease, neurological or mental health conditions reported having the worst experiences of all chronic care patients.
The survey also revealed a breakdown in communication between doctors and patients when it came to explaining care, finding that while many doctors were completing personalised GP Management Plans for patients, they were not always informing or involving the actual patient at the centre of the plan.
'In about 50 per cent of cases, people are not even aware that they've had one done,' Dr Marles says.
'We need to create those plans in partnership with our patients so that they actually understand what the tasks are for them in terms of self-management; what are the goals that we're hoping to achieve? Who are the other people involved in their care? It's a really important plan and I think it's an area that we need to focus on a bit more.'
Dr Fong suspects that will change following amendments introduced on July 1 that replace the existing GP Management Plan and Team Care Arrangements with a single GP Chronic Conditions Management Plan.
As part of the change, GPs may have access to additional Medicare billing benefits if they develop a plan for a patient with chronic conditions.
'As of July 1, there's much more emphasis on reviewing the plan periodically, approximately only three, four to six months,' Dr Fong says.
The report also found men were far more likely to trust the healthcare system than women, a trend that was not influenced by the gender of the healthcare provider.
Dr Marles says the cause of the distrust was not obvious from the findings, speculating it could be the result of more women seeking medical help for complex conditions including psychological issues.
'That's not to say that they have more psychological issues, it's just that they may seek help for mental health complaints more than men,' she says.
'Maybe there's some element of that medical misogyny, where they may feel dismissed around their concerns. It's very hard to drill down and find out exactly why that statistic is there based on the results.'
Dietitians Australia president Dr Fiona Willer believes the findings show the need for allied health professionals to be better embedded into primary care.
'We're failing at best practice here, it makes no sense for Australians at risk of, or living with, diet-related chronic diseases, like type-2 diabetes, not to be getting adequate access to dietitians,' she says.
'We can't expect GPs to be managing complex chronic conditions alone, for patients with multiple chronic conditions, comprehensive multidisciplinary team care is absolutely essential – and not the reality in Australia yet.'
It is hoped the findings will be used by policymakers and doctors to help fill national healthcare gaps.
Lesley Hoatson hopes that happens.
'This is really about social justice issues, because not everyone gets access to those sorts of services like continuity of care,' she says.
'It's made a big difference to my life, and I reckon there'd be very few people who wouldn't want that. It's just that they can't necessarily get access to it.'