Whither Divisions of General Practice? An empirical and policy analysis of the impact of Divisions within the Australian health care system.
OBJECTIVE
To examine the effect of Divisions of General Practice on various measures of primary care performance.


METHODS
Regression analysis using longitudinal data across Australia.


METHODS
All Divisions of General Practice between 2002 and 2004.


METHODS
Fourteen indicators of primary care performance in the areas of general practice infrastructure, access, multidisciplinary working, chronic disease, and measurable aspects of quality of care.


RESULTS
Between 2002 and 2004, Divisions and the activities they performed were associated with a number of measures of primary care performance, particularly measures of general practice infrastructure. Of the total variation in each performance indicator, between 19% and 64% can be attributed to the influence of Divisions while controlling for remoteness, health needs, and general practitioner characteristics. In all regression models, these effects were significant (P < 0.05). Divisions that provided support in electronic communication and electronic transfer of data were associated with: a 0.56 (95% CI, 2 0.04 to 1.2; P = 0.07) percentage point increase in the proportion of Practice Incentives Program (PIP) practices; a 0.73 (95% CI, 2 0.09 to 1.5; P = 0.08) percentage point increase in the proportion of PIP practices with electronic prescribing software; and a 0.66 (95% CI, 0.05 to 1.3; P = 0.03) percentage point increase in the proportion of PIP practices with a modem. Divisions providing activities with an asthma focus were associated with a 0.84 (95% CI, 0.02 to 1.5; P = 0.01) percentage point increase in the proportion of PIP practices receiving the asthma sign-on payment. There were no significant effects of Division activities on clinical aspects of care, such as GP claims for Service Incentive Payments for asthma, diabetes or cervical screening.


CONCLUSIONS
Divisions of General Practice had an effect on primary care performance in a difficult health system context.
Scott
Anthony
A
Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia. a.scott@unimelb.edu.au
Coote
William
W
D001315:Australia; D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards