CHARACTERISTICS OF LONGER CONSULTATIONS IN AUSTRALIAN GENERAL-PRACTICE

Objective: To assess the association between general practitioner (GP) billing for ''longer'' consultations, patient factors linked with hea lth care need, and other consultation characteristics. Design: Retrosp ective analysis of data from Medicare (1984-1992), Australian Morbidit y and Treatment Survey (1990-1991) and Australian Capital Territory Re cord Linkage Study (1988-1992). Setting: Australian general practice, 1984 (introduction of Medicare) to 1992.Main outcome measures: Consult ations billed as longer (greater than or equal to 20 or > 25 minutes) compared with standard; type of billing (bulk or private); patient hea lth care need (defined as health and sociodemographic factors linked t o worse health outcomes); consultation continuity, type of care given and number of problems managed. Results: Longer billed consultations i ncreased between 1984 and 1992, from 2.8% to 6.7% of all standard and longer consultations. Longer consultations were more likely to be bulk -billed than privately billed (odds ratio [OR], 1.74). They were more likely than standard consultations to deal with psychological diagnose s (OR, 2.06; 95% confidence interval [95% CI], 1.83-2.32) or multiple problems (OR for four versus one diagnosis, 5.18; 95% CI, 4.31-6.22) a nd to involve patients aged under 50 years, new to the practice or wit h new problems, but not chronic disease. In the ACT, those billed for longer consultations were more commonly tertiary educated (OR, 1.99; 9 5% CI, 1.35-2.94), bulk-billed (OR, 2.75; 95% CI, 2.51-3.10), aged 40- 49 years and non-obese. Conclusion: Longer billed consultations were n ot associated with greater patient need, other than psychosocial need, but with bulk billing and patient socioeconomic advantage. However, e valuation was complicated by the effects of continuity of care and num ber of problems managed in the consultation.