Inter-Practice Variability in General Practice Consultations With Older Patients: A Cross-Sectional Analysis of the Registrar Clinical Encounters in Training Study

Abstract

Rationale: General practice is central to older patient care provision. For GP registrars (specialist GPs in training), exposure to older patients is also vital for developing chronic disease and multimorbidity management skills. However, registrars see fewer older patients, and are less engaged with older patient care, than established GPs.

Aims and objectives: This study aimed to assess inter-practice variability in the proportion of older patients seen by Australian GP registrars during training.

Method: Cross-sectional analysis from the ReCEnT study of GP registrars' clinical experiences (2010-2023). The outcome was consultation with older (65+ years) patients. Inter-practice variability was assessed with Intraclass Correlation Coefficient (ICC) and Median Odds Ratio (MOR). Outcome variance attributable to practice was estimated within the Bayesian modelling framework using a mixed-effects logistic regression with cross-classified random effects for registrar and practice.

Results: The analysis included 4643 registrars across 978 practices. 19% (129,659/688,281) of consultations were with older patients. The ICC was 0.15 (95% Credible Interval (CrI) [0.14, 0.17]) in a model with a random effect for practice; and, in a model adjusted for time/registrar/patient/practice variables, 0.10 (CrI [0.09, 0.11]). These values (comparable with, or higher than, reported for other general practice variables), indicate registrars' older patient clinical exposure is dependent upon the practice(s) trained in. The MOR was 2.08 (CrI [(2.00, 2.16]); and, adjusted, 1.81 (CrI [1.76, 1.87). By randomly changing practice location, the odds of a registrar's consultation being with an older patient thus approximately doubles (or, alternatively, halves) on average.

Conclusion: The practice itself is the greatest determinant in registrars' exposure to older patients. Practice-level interventions are essential to improve registrars' in-training older patient care experience.

Keywords: medical education; older patients; primary care.