Doctors, practices, patients, and their problems during usual hours: a description of rural and non-rural primary care in New Zealand in 2001-2002.

AIM: To describe the characteristics of patients who attended rural general practice offices in New Zealand in 2001/2 during normal hours along with the problems they presented and the management that they received. Comparisons are made with patients who attended non-rural practices.

METHODS: Data were collected from a stratified random survey of GPs in New Zealand as part of the National Primary Medical Care survey carried out in 2001/2.

RESULTS: Response rates at rural and non-rural general practices were high (72%). Comparing practice characteristics by locale, there were fewer full-time equivalent doctors in rural settings, their practice fees were lower, their throughput was slightly higher, and more services were provided (such as evening surgery, group health promotion and doctors involved in maternity care). More rural practitioners had graduated overseas than their urban counterparts but their characteristics were otherwise similar. Patients who presented to rural practices were similar in age and gender, but a higher proportion were M?ori and more were from more deprived areas. Patients made a similar number of visits as people in non-rural areas, although visits were slightly shorter in rural practices and more were funded by Accident Compensation Corporation (ACC). Rural patients presented slightly fewer reasons or problems per visit. Injury and respiratory conditions were more frequent problems managed at rural practices. Patient management was generally similar regardless of location, although laboratory tests and other investigations were ordered less frequently at rural practices. Prescriptions and non-drug treatments were also provided slightly less often at rural practices and follow-up was arranged less frequently.

CONCLUSIONS: Aside from a few key differences, the characteristics of patients, practitioners, and practice were generally similar between rural and non-rural locations during normal hours in 2001/2. With some notable exceptions, patient problems and their management were also broadly consistent. Further work is needed to develop an ongoing database of patient morbidity encountered in primary care, ideally with more information about the complexity of each encounter and the nature of after-hours work.