On the BEACH

About 85 per cent of Australians visit a GP at least once in any year. Altogether, that amounts to roughly 100 million consultations annually. Every consultation is unique, because every patient is an individual, each with their own unique combinations of complaints - morbidity and associated other illnesses - and differing from each other in age, gender and background.

That makes assessing the value the community gets from the $2.5 billion a year spent in direct costs, and the further $7.5 billion a year in secondary costs - such as drugs prescribed and specialist referrals and pathology - on GP visits, not to mention the health outcomes, a hugely complex task. So for decades the Family Medicine Research Centre at the University of Sydney and its predecessors have been developing and refining methods to improve the quality of its data about patients and "true life" outcomes.

The result of their work is BEACH (Bettering the Evaluation And Care of Health), a continuous national survey of GPs and the patients they treat, launched in 1998 with the aim of studying what goes on in GP surgeries and the outcome of the consultations. BEACH relies on data quality methodology developed within the Department of General Practice at the University of Sydney (which gave birth to the Family Medicine Research Centre in August 1999), refined during comparisons with population-reported information such as that found in the Australian Health Survey.

"The ideal research would be able to test in real life what happens when a real patient with mixed morbidity and a specific lifestyle is given a product as a treatment - looking at real-life effectiveness, rather than efficacy of treatment - which is what is being tested in randomised controlled trials," says associate professor and director Helena Britt. "Now this is just huge - it is just fraught with difficulty, so for the past 30-odd years we've been developing methods to allow us to at least look at the consultations."

Britt says the very size of the task, not to mention the complexities involved and the solutions determined, have cast significant light on selective aspects of the ongoing issues of data quality facing many organisations. She says the lessons she has learned about data quality have been invaluable.

Data collection and assessment for the survey have proven enormously complex, Britt says. For instance, a major issue in collecting data in Australian health is that it is very difficult to follow a patient. A researcher might think they have the patient's full general practice medical record on their desk, when in fact the patient may very well have visited several other doctors, either within the same practice or externally.

Nevertheless, Britt's team developed a method within the University of Sydney General Practice, as it was then, and worked out methods of collecting usable longitudinal patient data on its own patient population. "And that's fine; that can work in a single general practice because you are representing - you think - your practice population. It sounds pretty simple. But it is actually not easy in Australia to define your practice population. Next we tested whether data collected from GPs at the consultation actually 'reflects' population-reported information, as is collected in the Australian Health Survey," Britt says.

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