2017 AMA Aged Care Survey Report 2017 AMA Aged Care Survey Report Contents Summary .................................................................................................................................... 1 Method ...................................................................................................................................... 3 Data size and integrity ............................................................................................................ 3 Assumptions and expectations .............................................................................................. 3 Questions ............................................................................................................................... 3 Results ........................................................................................................................................ 5 Demographics......................................................................................................................... 5 Gender ................................................................................................................................ 6 Age ...................................................................................................................................... 8 Practice arrangements ..................................................................................................... 10 Years in practice................................................................................................................ 13 Medical practitioners who visit Residential Aged Care Facilities ........................................ 15 Average number of patients in RACFs .............................................................................. 15 Time spent on RACF patients ........................................................................................... 15 Quality of care in aged care settings .................................................................................... 20 Elder abuse ....................................................................................................................... 20 Aged Care Accreditation Standards .................................................................................. 21 Access to aged care services............................................................................................. 22 Access to the facility, infrastructure, and external services ............................................. 25 Intentions to visit RACFs....................................................................................................... 30 Factors influencing intentions to visit over past five years .............................................. 33 Advocating for a better aged care system ........................................................................... 37 Discussion................................................................................................................................. 37 Appendix .................................................................................................................................. 38 Date published: July 2018 2017 AMA Aged Care Survey Report Summary The 2017 AMA Aged Care Survey (the survey) sought feedback on AMA members’ impressions and experiences of providing medical care to older people. The survey results provide insight into the perceptions and priorities of members in providing medical care in the aged care sector. As older Australians living in Residential Aged Care Facilities (RACFs) require a high level of medical care, many of the questions are focused on medical access in RACFs. In 2017, there was significant aged care system review by the Federal Government and consultation with stakeholders regarding the quality of care older Australians receive – therefore, quality of care questions were included, in order for the AMA to accurately understand members’ current views. This survey has been conducted in 2008, 2012, 2015, and now 2017. The 2017 survey revealed that, since the 2015 survey, medical practitioner visits have increased by 1.2 visits (from 7.4 to 8.6 visits per month) while the average number of patients seen per visit has remained relatively similar, with only a slight increase of 0.1 patients per visit (from 6.5 to 6.6 patients per visit). However, the average reported non-contact time on each patient seen (13minutes 35 seconds) has decreased since 2015 (17 minutes 30 seconds), although is similar to the 2012 average (13 minutes 54 seconds). Although non-contact time has decreased, several members remain concerned about non- contact time demands, commenting on the considerable amount of paperwork involved, responding to faxes and phone calls, and discussing issues with RACF staff or relatives of residents. This has been a common concern for respondents of all the surveys and was listed as a major influence to decrease visits, or never visit, RACFs (page 35 and 36). All surveys indicate an increased demand for RACF-visiting medical practitioners. The average reported time spent on each patient has increased since previous years. The 2017 survey saw an average of 17 minutes 7 seconds spent on each patient, while in 2012 and 2015, the average was 16 minutes 6 seconds and 16 minutes 12 seconds, respectively. This indicates that although the number of patients seen per visit remains the same, medical practitioners are making more visits to RACFs and spending slightly more time with each patient. Respondents aged 41-60 remain the largest age group reporting they visit RACFs (46.94 per cent) and contributing to the highest proportion of monthly visits (49.32 per cent). Respondents aged 61 and over contribute to 47.11 per cent of monthly RACF visits, and those aged 40 or under contribute to only 3.57 per cent. This raises concerns that as the older age groups move into retirement, there could be a shortage of medical practitioners willing to visit patients in RACFs. Respondents were asked of their intentions to visit RACFs over the next two years. Over one third (35.67 per cent) of respondents who currently undertake RACF visits intend to either visit current patients but not visit new patients, decrease the number of visits, or stop visiting RACFs altogether. Page | 1 2017 AMA Aged Care Survey Report Respondents were also asked why the quantity of their RACF visits had changed in the past five years. Nearly half (48.48 per cent) of respondents ‘agreed’ that the reason they had decreased their visits to RACFs was because unpaid non-face-to-face time is increasing, while 40.82 per cent agreed that the decrease was due to a too-busy practice. The two reasons that were rated the highest under the ‘strongly agree’ category include that unpaid non-face-to- face time is increasing (34.34 per cent) and that patient rebates are inadequate and do not compensate for lost time in the surgery (33.33 per cent). Similarly, influences to never visit RACFs are mostly fee-related, with 35.29 per cent strongly agreeing that never visiting RACFs was due to an increase in unpaid non-face-to-face time, and 32.84 per cent stating that patient rebates are not adequate and do not compensate for lost time in the surgery. In all the surveys, respondents were asked to rate the importance of measures to improve access and quality of medical care in RACFs. Respondents, similar to previous years, marked the following measures as ‘urgent’ and ‘extremely urgent’: • improve availability of suitably trained and experienced nurses and other health professionals (65.92 per cent) • increase funding for medical practitioners (57.55 per cent). Other ‘urgent’ and ‘extremely urgent’ measures included: • improve access to palliative care services (54.10 per cent) • improve access to mental health services in RACFs (53.17 per cent) • reduce polypharmacy to lower the risk of adverse health events in older people (51.23 per cent) • improve access to specialist care (such as geriatrician, palliative care, psychiatric, renal, cardiac, and diabetic) (49.29 per cent). These high ratings of urgency for the above measures indicate that respondents believe the quality of care and access to care for older Australians is sub-par and must be addressed quickly. Page | 2 2017 AMA Aged Care Survey Report Method Data size and integrity The survey was distributed to 5,599 AMA Members who identify as general practitioners (GPs), consultant physicians, and palliative medicine and geriatrician specialists in early November 2017 via an email from Dr Michael Gannon, AMA President (2016-2018). These members were sent a reminder email one week before the survey closed. Members were given three weeks to complete the survey. The survey was also promoted via articles in GP Network News, Australian Medicine and AMA Rounds, and a notification was published on the Federal AMA home page (ama.com.au). 608 members responded to the survey. As no question was compulsory, the results of each question have different sample sizes. Sample sizes are indicated below each graph, or in each results section. Assumptions and expectations As many of the questions were framed in order to give expression to frustration, a greater proportion of negative responses toward providing medical care to older Australians were expected than positive ones. It is likely that respondents (correctly) expected the AMA to be interested in improving the existing arrangements for providing medical care in RACFs, and thus had an incentive to concentrate on critical responses. Questions The main objective of the survey was to compare results to the previous surveys and identify trends in access to medical care in aged care settings. For this reason, the majority (72.72 per cent) of questions have not changed since the 2015 survey. However, individual responses were confidential, and it could not be determined whether the same AMA members are completing the survey each year. Therefore, the survey represents trends of AMA members as whole. As there has recently been significant media attention, government consultation with stakeholders, and policy reform in the aged care system, additional questions were created to better inform the AMA’s advocacy strategy to improve medical access to older Australians. New questions are Q3, 15, 26-31, 33, and 40-43 covering issues such as Medicare Benefits Schedule (MBS) items, access to infrastructure, clinical communications, and the quality of aged care providers. The survey was carried out through Survey Monkey1. In total, there were 45 questions in the survey, however, different questions were asked according to the participant’s answer 1 https://www.surveymonkey.com/ Page | 3 2017 AMA Aged Care Survey Report pathway. The maximum number of questions a participant could answer was 36 (see Figure 1). A list of the questions is provided in the Appendix. Page | 4 2017 AMA Aged Care Survey Report Demographics (8) Accessing aged care services (4) Visiting aged care facilities and people at home (5) Dividing Q: Do you visit RACFs? No Yes Dividing Q: Please indicate which of the following best describes you MPs who visit RACFs (17) Stopped visiting RACFs <5 Stopped visiting > 5 years Dividing Q: Have your visits years (1) (0) Never visited (1) to RACFs... Remained relatively Advocating for a better Advocating for a better Increased (1) Decreased (1) Quality of care in RACFs (4) constant (1) aged care system (2) aged care system (2) Advocating for a better Quality of care in RACFs (4) Quality of care in RACFs (4) Quality of care in RACFs (4) aged care system (2) Advocating for a better Advocating for a better Advocating for a better aged care system (2) aged care system (2) aged care system (2) Figure 1: Flow chart of questions for the 2017 AMA Aged Care Survey. Numbers in brackets identify the number of questions in each segment. Page | 4 2017 AMA Aged Care Survey Report Results Demographics Respondents are grouped into four categories (Figure 2): • Medical practitioners who visit RACFs (63.75 per cent), • Medical practitioners who stopped visiting at some point during the past five years (10.51 per cent), • Medical practitioners who have never regularly visited a RACF (15.76 per cent), and • Medical practitioners who stopped visiting RACFs more than five years ago (9.98 per cent). Figure 2: Which respondents visit RACFs or have in the past (n=571). Page | 5 2017 AMA Aged Care Survey Report The proportion of respondents who visit RACFs has decreased by 13.55 per cent since the 2015 survey (Figure 3). Figure 3: Proportion of respondents who visit RACFs, in comparison to previous surveys (2008, 2012, 2015). Gender Nearly two-thirds (60.86 per cent) of survey respondents were male; 37.50 per cent were female; two respondents (0.33 per cent) identified as a gender other than male or female; and eight respondents did not supply a gender (1.32 per cent). The proportion of male respondents who visit RACFs was higher than the proportion of female respondents. (62.97 per cent compared to 54.39 per cent, respectively) (Figure 4). Similarly, the proportion of female respondents who have never regularly visited RACFs was higher than the proportion of men (18.86 per cent compared to 12.43 per cent, respectively). In comparison to previous years (Figure 5), the proportion of respondents who do not visit RACFs for both genders has increased since 2012 and 2015. However, the proportion of female respondents who did not visit in 2017 is similar to that reported in 2012. Page | 6 2017 AMA Aged Care Survey Report Figure 4: Proportion of males and females who visit RACFs (n=598) Figure 5: Comparing the proportions of genders who visit RACFs with previous surveys (this data was not collected in 2008). Page | 7