3 Method
3.2 The BEACH method
3.2.5 Data elements
Three interrelated sets of data were collected in BEACH: encounter data; GP and practice data; and substudies of various topics. The substudies, referred to as SAND (Supplementary Analysis of Nominated Data), are described in Section 3.2.6.
Figure 3.1 describes the relationships between the BEACH data elements diagrammatically. All variables can be directly related to GP and patient
characteristics and to the encounter. All types of management (including pathology tests) are directly related to one or more problems being managed at the encounter.
The data used in this thesis are highlighted in Figure 3.1, and defined below.
Encounter data
In BEACH, the encounter was defined as any professional interchange between a patient and a GP. Encounters can be ‘direct’‡ involving face-to-face meeting between the GP and patient or ‘indirect’‡ where there was no face-to-face contact but a
service was provided (e.g. a prescription or referral arranged by telephone).
Encounter data elements were collected on the encounter form (Appendix 2) and included details about the encounter itself, the patient, the problems that were managed and the management provided. The encounter data were cross-sectional.
Therefore, the problems managed and the management provided reflect the encounter activity.
Figure 3.1: The BEACH relational database
Note: FTE—full-time equivalent; FRACGP—Fellow of the Royal Australian College of General practitioners; DVA—
Department of Veterans’ Affairs; NESB—non-English-speaking background; SAND—Supplementary Analysis of Nominated Data.
The encounter
date
direct (face to face)
— Medicare Benefits Schedule item number(s) claimable
— workers compensation
— other paid
— no charge
indirect (e.g. telephone)
Patient substudies (SAND)
risk factors
— body mass
— smoking status
— alcohol consumption
other topics
Management of each problem Medications (up to four per problem)
— drug status (new/continued) Other treatments (up to two per problem)
procedural treatments
clinical treatments (e.g. advice, counselling)
practice nurse involvement Pathology tests ordered (up to five per encounter)
individual tests (e.g. glucose test) or batteries of tests (e.g. lipid profile) Other management
referrals (up to two per encounter)
— to specialists
— to allied health professionals
— to emergency departments
— hospital admissions
imaging ordered (up to three per encounter)
GP characteristics
age and sex
years in general practice
country of graduation
number of sessions per week
FRACGP status (yes/no)
currently a registrar (yes/no)
Practice characteristics
practice size (FTE GPs)
postcode
accreditation status
after-hours arrangements
teaching practice (yes/no)
The patient
age and sex
practice status (new/old)
Concession card status
DVA status
postcode of residence
NESB/Indigenous status
reasons for encounter
Problems managed
diagnosis/problem label
problem status (new/old)
work-related problem status
Encounter details
The only data element describing the encounter that is used in this thesis, is the MBS item number (Box 3.1). It is used to classify the encounter as level A, B, C or D‡ (where applicable) based on the type of GP–patient consultation. These MBS levels are defined in the glossary.
Box 3.1: Encounter data elements
Element Definition and format Medicare Benefits Schedule item
number‡
Item number recorded as claimable for the encounter. Up to 3 item numbers per encounter (Free text number)
‡ Definition of term is included in glossary.
The patient
Data elements about the patient used in this thesis are described in Box 3.2. The
‘Health concession card’‡ variable used in Chapter 7 is a binary variable that was created using the health care/benefits card‡ and Repatriation health card‡ data elements. A patient with either of these cards was classed as having a health concession card.
Box 3.2: Patient data elements
Element Definition and format
Age Day (2 digit number), month (2 digit number) and year (4 digit number) of the patient’s date of birth
Sex Male, Female (Tick box)
New patient status‡ Indicates whether this is the patient’s first visit to the practice (Yes/No tick box)
Health care/benefits card‡ Patient holds a card entitling them to a higher level of Government subsidy for health services. Examples of patients who may be eligible include pensioners, unemployed, low income earners (Yes/No tick box)
Repatriation health card‡ Patient holds a card from the Department of Veteran’s Affairs entitling them to a range of Repatriation health care benefits (Yes/No tick box)
‡ Definition of term is included in glossary.
The problems managed
Data elements collected about a problem under management at the encounter that are used in this thesis, are described in Box 3.3.
Box 3.3: Data elements about the problems managed
Element Definition and format
Diagnosis/problem‡ A statement of the provider’s understanding of a health problem presented by a patient, family or community. GPs are instructed to record at the highest diagnostic level possible from the information available at the time. It can be recorded as a symptom, morbidity or process of care.
At least one and up to four problems can be recorded per encounter. Free text
Problem status, either ‘New’‡ or ‘Old’‡ New problem is defined as the first presentation of a problem, including the first presentation of a recurrence of a previously resolved problem, but excluding the presentation of a problem first assessed by another provider.
Old problem is defined as a previously assessed problem that requires ongoing care, including follow-up for a problem or an initial presentation of a problem previously assessed by another provider.
New/Old tick box for each problem.
‡ Definition of term is included in glossary
Pathology tests ordered and other management provided
In BEACH, several types of management actions could be recorded, and all of these management activities were linked by the GP to the problem (or problems) for which they were given.
In this thesis, pathology data are the main type of management data used. GPs recorded each pathology test in free text as either a single test (such as fasting glucose test) or a battery of tests‡ (such as a lipid profile) (Box 3.4). Up to five pathology tests or batteries of tests can be recorded per encounter. Each pathology test or battery must be linked to at least one problem but could be linked to up to four problems managed (the maximum recorded per encounter). This means that there can be a one-to-one, one-to-many or many-to-one relationship between pathology
tests/batteries and problems managed.
The medication ‘name’ data element was also used in Chapter 5 (Box 3.4).
Box 3.4: Data elements about pathology tests and other management of problems at the encounter
Element Definition and format Pathology
Single test (e.g. fasting glucose test) Battery of tests‡ (e.g. lipid profile)
Pathology tests/batteries of tests ordered by the GP at the encounter.
Up to five pathology tests or batteries of tests could be recorded per encounter. Each test or battery of tests was linked by the GP to the related problem or problems managed at the encounter for which the test was ordered.
Free text, and circle the problem number(s) to which the test related.
Medication
Details collected include: name, form (where required), strength, regimen.
Includes medications prescribed, supplied by the GP and advised for over-the-counter purchase.
Up to 4 medications could be recorded per problem, and a maximum of 16 medications could be recorded per encounter.
Tick boxes for GP-supply, and over-the-counter status.
Free text for other medication data variables.
‡ Definition of term is included in glossary
GP and practice data
In BEACH, a single page questionnaire was used to gather data about each
participating GP and their practice (Appendix 3). As it is possible for a GP to work at multiple practices, GPs were instructed to provide details about their major practice.
The GP and practice data elements used in this thesis are described in Box 3.5. In Chapter 7, the practice postcode was used to assign the relevant Australian State or Territory of the practice location, and to classify the rurality of the practice location using the Australian Standard Geographical Classification (ASGC) remoteness areas.107
Box 3.5: Data elements about the participating GPs and their practice
Element Definition and format
Age GP’s age. Free text (number).
Sex GP’s sex. Circle ‘male’ or ‘female’.
Years in general practice Number of years spent in general practice. Free text (number).
Fellowship of the Royal Australian College of General Practitioners (FRACGP)
Status of the GP as a fellow of the Royal Australian College of General Practitioner. Circle ‘yes’ or ‘no’.
Country of graduation Country where the GP’s primary medical degree was obtained.
Circle number to indicate one of the listed countries or record (in free text) an ‘other’ country.
Year of graduation Year in which primary medical degree was obtained. Free text (number).
Sessions per week/Workload Number of general practice sessions usually worked by the GP per week. A session is defined as approximately 4 hours e.g. a morning session. Free text (number).
Practice postcode Postcode of the major practice address. Free text (number).
Size of practice (number of full-time equivalent [FTE] GPs)
Number of FTE GPs, including the participating GP, who work at the major practice. Free text (number).
Accreditation‡ status Whether the major practice is accredited according to the Royal Australian College of General Practitioner standards.
Circle ‘yes’ or ‘no’.
Status as a teaching practice Whether the major practice provides training for undergraduate medical students and/or GP registrars. Circle a number(s) to indicate training provided.
‡ Definition of term is included in glossary.