Article Gold Open Access 2025

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

Journal of Evaluation in Clinical Practice
Journal · Vol. 31 · Issue 4 · Art. e70139
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. © 2025 John Wiley & Sons Ltd.

Keywords

Author Keywords

medical education Primary care older patients

Index Keywords

training adult clinical competence cross-sectional study female human male medical education questionnaire Cross-Sectional Studies Humans Article Australia education general practice general practitioner General Practitioners clinical practice normal human mentoring consultation aged employment status sensitivity analysis immunization interpractice variability logistic regression analysis motor performance socioeconomics Bayes theorem patient referral very elderly Aged, 80 and over Practice Patterns, Physicians' Referral and Consultation
Author Affiliations
GP Training Research, Royal Australian College of General Practitioners, East Melbourne, VIC, Australia, School of Medicine and Public Health, Callaghan, NSW, Australia, School of Population Health, UNSW Sydney, Sydney, NSW, Australia
GP Training Research, Royal Australian College of General Practitioners, East Melbourne, VIC, Australia, School of Medicine and Public Health, Callaghan, NSW, Australia
GP Training Research, Royal Australian College of General Practitioners, East Melbourne, VIC, Australia
GP Training Research, Royal Australian College of General Practitioners, East Melbourne, VIC, Australia, General Practice Clinical Unit, Faculty of Medicine, Brisbane, QLD, Australia, School of Medicine and Public Health, Callaghan, NSW, Australia
School of Medicine and Public Health, Callaghan, NSW, Australia
Hunter Medical Research Institute, Australia, Newcastle, NSW, Australia
General Practice Clinical Unit, Faculty of Medicine, Brisbane, QLD, Australia
Funding & Acknowledgements
No funding information
References 10 References
1 Population Ages 65 and Above of Total Population, (2024)
2 World Population Prospects 2022 Summary of Results, (2022)
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4 Chronic Conditions and Multimorbidity
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6 Pearlman, James, Continuity of care in general practice vocational training: Prevalence, associations and implications for training, Education for Primary Care, 27, 1, pp. 27-36, (2016)
7 Maarsingh, Otto R., Continuity of care in primary care and association with survival in older people: A 17-year prospective cohort study, British Journal of General Practice, 66, 649, pp. e531-e539, (2016)
8 Patient Experiences in Australia Summary of Findings
9 Patient Experiences
10 General Practice Workforce Providing Primary Care Services in Australia
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