General practitioner consultations at residential aged-care facilities

OBJECTIVES: To describe the patients seen and the clinical activity undertaken by general practitioners during encounters at residential aged-care facilities (RACFs), and to ascertain how these differ from all GP encounters in Australia as a whole. DESIGN AND PARTICIPANTS: A secondary analysis of encounter data from the Bettering the Evaluation and Care of Health (BEACH) study, April 2004 to March 2006, comparing RACF consultations (identified by Medicare item numbers) with all BEACH study encounters in Australia. Participants were a random sample of GPs who had claimed at least 375 general practice Medicare items in the 3 months prior to the study. MAIN OUTCOME MEASURES: Differences in the characteristics of GPs and patients at RACF consultations, morbidities managed, and treatments provided to patients. RESULTS: Over the study period there were 2310 RACF encounters out of a total of 197 000 BEACH encounters; 360/1970 GPs (18.4%) recorded at least one RACF consultation. GPs aged > or = 45 years were more likely to record at least one RACF consultation than those aged < 45 years. Patients were predominantly women (70.7%), and 83.4% were aged > or = 75 years. At RACF consultations, problems managed significantly more often included chronic problems, as well as psychological, neurological, urological, circulatory, eye and musculoskeletal problems. Dementia was the most common problem managed, at 33 times the usual management rate in everyday practice. Significantly fewer medications, non-pharmacological treatments, referrals, pathology and imaging tests were recorded at RACF consultations. CONCLUSION: GP encounters at RACFs involve the management of chronic and complex conditions, including some not frequently seen in everyday general practice. The provision of additional education and resources where required may assist with workforce shortages in this setting.     

The Threats to Australian Patient Safety (TAPS) study: incidence of reported errors in general practice

OBJECTIVE: To determine the incidence of errors anonymously reported by general practitioners in NSW. DESIGN: The Threats to Australian Patient Safety (TAPS) study used anonymous reporting of errors by GPs via a secure web-based questionnaire for 12 months from October 2003. SETTING: General practices in NSW from three groupings: major urban centres (RRMA 1), large regional areas (RRMA 2-3), and rural and remote areas (RRMA 4-7). PARTICIPANTS: 84 GPs from a stratified random sample of the population of 4666 NSW GPs - 41 (49%) from RRMA 1, 22 (26%) from RRMA 2-3, and 21 (25%) from RRMA 4-7. Participants were representative of the GP source population of 4666 doctors in NSW (Medicare items billed, participant age and sex). MAIN OUTCOME MEASURES: Total number of error reports and incidence of reported errors per Medicare patient encounter item and per patient seen per year. RESULTS: 84 GPs submitted 418 error reports, claimed 490 864 Medicare patient encounter items, and saw 166 569 individual patients over 12 months. The incidence of reported error per Medicare patient encounter item per year was 0.078% (95% CI, 0.076%-0.080%). The incidence of reported errors per patient seen per year was 0.240% (95% CI, 0.235%-0.245%). No significant difference was seen in error reporting frequency between RRMA groupings. CONCLUSIONS: This is the first study describing the incidence of GP-reported errors in a representative sample. When an anonymous reporting system is provided, about one error is reported for every 1000 Medicare items related to patient encounters billed, and about two errors are reported for every 1000 individual patients seen by a GP.     

Determinants of consultation length in Australian general practice

OBJECTIVE: To measure the independent effect on length of general-practice consultations of a range of characteristics of the general practitioner (GP), practice, patient and consultation, as a basis for considering future GP workforce needs. DESIGN: Secondary analysis of data from the BEACH (Bettering the Evaluation and Care of Health) study. SETTING AND PARTICIPANTS: Data were obtained from 1904 GPs Australia-wide on 70,758 consultations between 1 January 2001 and 31 December 2002; all consultations that were claimable from the Australian Government's Medicare system as General Practice Attendances and had recorded start and finish times were included. MAIN OUTCOME VARIABLES: Characteristics of the GP, practice, patient and consultation that were significantly related to consultation length, determined by multiple regression analysis. RESULTS: The following variables had an independent positive effect on consultation length: GP female, older, graduated in Australia, FRACGP-qualified, and in rural practice; patient female, older, new to practice, with higher socioeconomic status, no health concession card, more reasons for encounter, and more problems managed; and management of specific problem types (social, psychological and female genital problems), management of chronic disease, and provision of clinical treatments. CONCLUSION: The independent relationship of some GP, practice, patient and consultation characteristics with length of consultation may affect future GP supply. These factors should be considered in modelling future general practice workforce needs.     

Residential aged care and general practice: workforce demographic trends, 1984-2000

OBJECTIVE: To examine the demographic changes in the cohort of general practitioners servicing residential aged-care facilities (RACFs) from 1984 to 2000. DESIGN: Quantitative analysis of Medicare datasets from 1984 to 2000. PARTICIPANTS AND SETTING: All GPs who provided Medicare-claimed RACF services from 1984 to 2000. MAIN OUTCOME MEASURES: Aggregate data on RACF GPs by age group and sex; total and average number of RACF services by GP age group and sex. RESULTS: The proportion of RACF GPs younger than 35 years has declined from a peak of 30.2% in 1986 to 11.5% in 2000. GPs aged 45 years and older made up 58.1% of all RACF GPs in 2000, compared with 41.4% in 1984. In 2000, 28.4% of RACF GPs were female, compared with 13.5% in 1984. The proportion of RACF services provided by GPs younger than 35 years fell from 19.2% in 1984 to 4.5% in 2000, and the proportion provided by GPs aged 45 years and older increased from 54.7% to 72.4%. Female GPs' RACF services as a proportion of all RACF services increased from 8.9% to 15.9% between 1984 and 2000, but the average number of RACF services per female GP declined by 15.6 services per year. In contrast, the average number of RACF services per male GP increased by 11.2 per year. The increasing rate of RACF servicing by older GPs is independent of female GPs' declining involvement. CONCLUSION: Our results suggest an increasing reliance on older, male GPs in the supply of RACF services. Although the proportion of female RACF GPs has increased, average services by these GPs, who are generally younger, has declined. The personal and work preferences of female GPs may have implications for future RACF services supply as older, generally male, GPs retire.     

Workforce trends in specialist and GP obstetric practice in Victoria

OBJECTIVE: To provide a contemporary picture of the general practitioner and specialist obstetric workforce in Victoria. DESIGN, PARTICIPANTS AND SETTING: Postal census by questionnaire of all 317 Fellows and 961 Diplomates on the Victorian database of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in September 2003. MAIN OUTCOME MEASURES: Sex, age and geographical distributions and patterns of retirement from and recruitment to the GP and specialist obstetric workforce in Victoria. RESULTS: 244 Fellows (77.0%) and 652 Diplomates (67.8%) participated. The average age of Diplomates was 42 years; only 20% were involved in procedural obstetrics. Of GPs practising procedural obstetrics, 56% intended to cease within 7 years. Two-thirds of specialist obstetricians continued to practise obstetrics. Among those ceasing obstetrics, almost half had done so since 2000. Among Fellows ceasing obstetric practice, there is a peak in the 50-60-years age group, but cessation of obstetric practice occurred across all age groups. CONCLUSION: The proportion of GPs involved in procedural obstetrics has fallen markedly over the past decade, with half of those ceasing practice in the 40-50-years age group. New GPs entering the workforce with the Diploma and overseas doctors are unlikely to meet the procedural workforce shortfall. Attracting the large cohort of doctors aged 40-50 years back to obstetric practice must be a priority. Given the pattern of retirements from obstetrics, there will be insufficient numbers of specialists to maintain current levels of service. The reasons include non-participation in obstetrics by new graduates and international medical graduates, the inadequate number of new graduates, and the predominance of women among specialists aged under 40 years, whose work output tends to be affected by family commitments.     

Adverse drug events in general practice patients in Australia

OBJECTIVE: To investigate the frequency, cause, and severity of adverse drug events (ADEs) among general practice patients. DESIGN: Between May 2003 and February 2004, a subsample of 282 general practitioners in the BEACH (Bettering the Evaluation And Care of Health) data collection program recorded patient responses to questions about ADEs. MAIN OUTCOME MEASURES: Frequency, cause, and severity of ADEs; and frequency of hospitalisation and proportion of events that were preventable. RESULTS: From 8215 encounters, GPs reported that 852 patients (10.4%) had experienced an ADE in the previous 6 months. Patients aged over 45 years (versus under 45 years), children aged 1-4 years (versus older children), and female patients (versus male patients) were significantly more likely to have experienced an ADE. Most patients (83.5%) had experienced only one ADE, with 10.7% and 5.8% experiencing two and three or more events, respectively. For 71.9% of patients, one reason for the most recent event was a recognised side effect, followed by drug sensitivity (12.4%) and allergy (11.0%). Over half of patients were rated as having a "mild" event, with 35.8% rated as "moderate", and 10.0% as "severe". GPs classified 23.2% of events as preventable, and 7.6% of events resulted in hospitalisation. CONCLUSION: Our study reveals the high frequency of ADEs in patients attending general practice. This level of morbidity makes ADEs one of the most significant causes of morbidity in the Australian community.     

Baby boomer doctors and nurses: demographic change and transitions to retirement

OBJECTIVES: To examine the effect of demographic change on employment patterns for general practitioners, medical specialists and nurses since 1986, and to compare their patterns of retirement. DESIGN AND SETTING: Secondary analysis of previously unpublished Australian Bureau of Statistics Census data for the years 1986, 1991, 1996 and 2001. MAIN OUTCOME MEASURES: Age distribution of GPs, specialists and nursing workforce; attrition rates as GPs, specialists and nurses left the workforce; and hours worked according to age group. RESULTS: The age profile of the GP, specialist and nursing workforce has aged since 1986 (P < 0.001), with the "baby boomer" generation making up more than half the workforce in 2001. A large proportion of GPs continued to work beyond the traditional retirement age of 65 years, with nurses retiring at a younger age than doctors (P < 0.001). All GP cohorts worked fewer hours in 2001 than they did in 1986 (P < 0.001), with "generation X" GPs working fewer hours than the baby boomers did at the same age (P < 0.001). CONCLUSIONS: Attrition of baby boomer clinicians will place unprecedented pressure on the medical workforce, and policy makers face a critical challenge to ensure workforce needs are met over the next 20 years. Policies and incentives to encourage ongoing employment among older clinicians, albeit at reduced hours, are crucial if the Australian health workforce is to be adequate to meet the growing community demand of the 21st century.     

The independent effect of age of general practitioner on clinical practice

OBJECTIVE: To establish the extent to which general practitioner age alone explains variations in patient morbidity and treatment patterns. SETTING: An on-going, national survey of general practice activity in Australia. PARTICIPANTS: A random sample of 5013 GPs with a minimum of 375 general practice Medicare items claimed in the previous 3 months. Each GP contributed details of 100 consecutive encounters, with about 1000 GPs sampled each year between 1998 and 2003. MAIN OUTCOME MEASURES: Effect of practitioner age on GP activity after removing the influence of measured confounding factors: doctor, patient and practice characteristics; number of problems; and morbidity managed at encounters. RESULTS: GP age played a significant role in practice style. In comparison with young GPs (< 35 years), older GPs provided more home visits (P < 0.001) and attendances at residential aged-care facilities (P = 0.044); were more likely to manage chronic problems (P < 0.001); had higher prescribing rates (P < 0.001), and lower rates of pathology ordering (P < 0.001) and non-pharmacological treatments (P < 0.001). Individual body system management rates also differed significantly between younger and older GPs. CONCLUSION: A GP's age plays a significant role in determining practice style. Our results have implications in terms of the ageing GP population and in the wider context of the ageing medical labour force.     

Estimating Australia's abortion rates 1985-2003

AIM: To estimate national rates of induced abortion in Australia from 1985 to 2003, using Medicare claim statistics for private patients and hospital morbidity statistics for public patients. DESIGN AND SETTING: Estimates were based on Australian and South Australian data collections relating to abortions. SA hospital morbidity statistics were compared with SA statutory notifications of abortions to estimate the accuracy of these collections. Medicare statistics on abortion procedures performed on private patients in South Australia were then compared with hospital morbidity statistics for private patients. National statistics on abortion derived from Medicare and hospital morbidity statistics were adjusted for inaccuracies found in these sources. MAIN OUTCOME MEASURES: Numbers of induced abortions in Australia for each year from 1985 to 2003; abortion rates per 1000 women aged 15-44 years. RESULTS: Abortion numbers based on Medicare claims by private patients overestimated by 18.7% the number of abortions derived from statutory notifications in South Australia during the period 1988-89 to 1999-00. Hospital morbidity data using principal diagnosis codes relating to medical abortion overestimated statutory notifications by 2.3% (mainly because of readmissions). National statistics were adjusted for these overestimations and for the estimated 14.1% of private patients who would not have submitted Medicare claims (based on surveys of private-clinic patients in New South Wales and Victoria). The estimated Australian abortion rate increased from 17.9 per 1000 women aged 15-44 in 1985 to a peak of 21.9/1000 in 1995, then declined to 19.7/1000 in 2003 (estimated number of abortions, 84,460). CONCLUSION: There are no data currently available for deriving accurate numbers of induced abortions in Australia. Suggestions are made for collection of national statistics.     

Fewer medical graduates are choosing general practice: a comparison of four cohorts, 1980-1995

OBJECTIVE: To compare general practice career choices of four cohorts of medical graduates. DESIGN AND SETTING: Retrospective longitudinal study of medical graduates. Data on employment since graduation, nature of current employment, and postgraduate qualifications were collected by postal survey in 2003. PARTICIPANTS: Four cohorts of Monash University Medical School graduates who completed their degrees in 1980, 1985, 1990 and 1995 (n = 386). MAIN OUTCOME MEASURE: Proportion of each cohort pursuing a general practice career. RESULTS: At 8 years after graduation, half of the graduates in the 1980 and 1985 cohorts were working in general practice, compared with 38% of 1990 graduates and 33% of 1995 graduates. Differences were mainly attributable to fewer female graduates working as GPs: female GPs comprised 62% of the 1980 cohort compared with 31% of the 1995 cohort. Graduates in more recent cohorts also entered the general practice workforce at a later stage than those in earlier cohorts. CONCLUSION: A rapidly declining proportion of new graduates from Monash University Medical School, particularly female graduates, are choosing general practice as a career. This will exacerbate future shortages in the general practice workforce.     

General practitioner views on barriers and facilitators to implementation of the Asthma 3+ Visit Plan

AIM: The Asthma 3+ Visit Plan is an initiative to promote organised asthma care in general practice. This study aimed to identify factors associated with uptake of the plan by general practitioners, and their views on barriers and facilitators to implementation of the plan. DESIGN: Postal survey sent to a random sample of GPs. PARTICIPANTS AND SETTING: 315 GPs in five Divisions of General Practice in metropolitan Sydney, surveyed sequentially between 1 October 2002 and 31 May 2003. OUTCOME MEASURES: Awareness and use of the Asthma 3+ Visit Plan; GP and practice factors associated with use of the plan; and GP views on barriers and facilitators to implementing the plan. RESULTS: The response rate was 55.7%, and 72.1% of participants were male; participants' mean age was 50.5 years. Most GPs (91.2%) were aware of the plan and and 44.9% had used it. GP and practice factors associated with use of the plan were use of the six-step Australian Asthma Management Plan, confidence in aspects of asthma care, practice accreditation, sign-up for asthma incentives, and computerisation. Major barriers to implementing the plan were workload/paperwork and administrative complexities. Patient factors that influenced completion of the plan were their concept of the severity of their asthma, compliance with follow-up, and patient attitudes towards asthma care. CONCLUSION: The perceived workload and administrative complexity of the asthma incentives are barriers to uptake. Factors relating to the illness rather than social factors are seen as the most important influences on completion of the plan by patients.     

Skin cancer surgery in Australia 2001-2005: the changing role of the general practitioner

OBJECTIVE: To describe changing patterns of skin cancer surgery by Australian general practitioners and make comparisons with specialists. DESIGN AND SETTING: Analysis of Medicare Australia item number reports for skin cancer excisions and for flap and graft repairs between 2001 and 2005. MAIN OUTCOME MEASURES: GPs' and specialists' rates of non-melanoma skin cancer (NMSC) excisions, melanoma excisions, flap repairs and graft repairs; excision to flap ratios. RESULTS: NMSC excisions in Australia increased from 338 712 (2001) to 451 628 (2005), a mean annual increase of 1.11/1000 population (P = 0.04); GPs did 51.1% of excisions in 2001, increasing to 54.4% in 2005, representing a higher mean annual rate increase than in specialists (P = 0.003). Nationally, melanoma excisions increased from 20 414 (2001) to 25 580 (2005); GPs did 34.3% of excisions in 2001, increasing to 35.8% in 2005--a similar mean annual rate increase to that in specialists (P = 0.25). Total flap repairs increased from 58 550 (2001) to 80 742 (2005); GPs did 21.3% of flap repairs in 2001, increasing to 26.9% in 2005--a similar mean annual rate increase to that in specialists (P = 0.83). Nationally, the excision to flap ratio for GPs fell from 14 : 1 (2001) to 12 : 1 (2005); in Queensland the ratio fell from 14 : 1 to 9 : 1 over the same period. CONCLUSION: GPs excise the majority of skin cancers, and the proportion excised by GPs is increasing. GPs are increasingly using skin flaps for repair, suggesting substantial changes to patterns of treatment, especially in Queensland.     

Where there is no surgeon: the effect of specialist proximity on general practitioners' referral rates

OBJECTIVE: To determine the effect of proximity of surgical specialists on general practitioners' (GPs') rates of referral of surgical problems to specialist care (ie, are surgical referral rates of GPs in rural or remote areas similar to those of GPs in urban centres?). DESIGN: A cross-sectional survey of GP-patient encounters. SETTING: The Bettering the Evaluation and Care of Health (BEACH) program, which involves all active registered GPs in Australia. PARTICIPANTS: A random sample of 3030 GPs, each providing details of 100 consecutive patient encounters. MAIN OUTCOME MEASURES: Proportion of surgical problems (including ophthalmological and obstetric and gynaecological) referred to surgical specialists (surgeons' rooms, hospital outpatient departments or hospital emergency departments). RESULTS: Absence of a local specialist did not significantly influence the proportion of surgical problems referred by GPs overall, but the proportion referred was significantly lower for obstetric (odds ratio [OR], 0.56; 95% CI, 0.44-0.70) and ophthalmological (OR, 0.60; 95% CI, 0.49-0.73) problems. Other factors independently associated with referral of a lower proportion of problems included male GPs, female and younger patients, holders of a Health Care Card, injury-related and non-cancer-related problems, follow-up presentations, and more than one problem managed at an encounter. CONCLUSIONS: Our findings confirm that rural and remote GPs undertake much of their patients' antenatal care, and are less likely to use specialists when managing ophthalmological problems. Absence of local specialists in other surgical specialties is not a barrier to referral of patients with surgical disorders.     

河南大型综合医院首批全科住院医师规范化培训学员毕业前现况调查研究

背景　全科住院医师规范化培训（住培）学员作为住培的参与主体,其对住培的现况反馈评价可直接反映培训的效果和质量,影响全科相关政策研究制定。目的　分析大型综合医院全科住培教育情况,查找存在的问题及产生的原因,为今后更好地做好全科住培工作提供参考,并逐步完善全科住培教育,为国家培养高水平的全科医生。方法　于2018年5-6月,采用整群抽样法选择郑州大学第一附属医院2018年6月结业的全部全科学员共200例为调查对象。通过无记名问卷调查和书面访谈了解住培学员情况。问卷主要包括5部分：全科住培学员的基本情况,全科学员的住培情况,对全科理念的了解情况,对全科住培情况的反馈,全科学员就业的基本情况。结果　共发放调查问卷200份,回收有效问卷200份,问卷有效回收率为100.0%。7.5%（15/200）的学员在2年内未通过执业医师考试;10.5%（21/200）的学员延期结业;94.3%（182/193）的学员在住培3年中受到导师良好的培养和影响;通过3年的全科住培,对全科非常了解的学员比例达到了83.0%（166/200）,愿意从事全科工作的学员比例提升到了83.0%（166/200）;在扎根基层全科工作的信心程度方面,仅有14.5%（29/200）的学员表示很有信心;113例订单定向学员中,52.2%（59/113）愿意回到基层工作,但3年后仅10.6%（12/113）的学员愿意留在基层;26例已找到工作的社会全科学员中,88.5%（23/26）继续从事临床工作,其中在三级甲等医院工作的学员占21.7%（5/23）;15例委培学员中93.3%（14/15）的学员单位是县级医院。21例延期结业的学员中有61.9%（13/21）是因为休产假而延期,执业医师考试未通过和身体原因各占19.0%（4/21）。结论　住培基地应加强学员基础知识、临床技能和全科理念的综合培养,进一步提高全科学员的职业认同感,推广规范双导师制的培养模式,提升学员的综合竞争力,加强带教师资队伍建设,多方面保障全科住培效果,依据全科就业真实状况,探寻提高基层全科岗位吸引力的方法。     

Re-licensing of general practitioners using the current UK revalidation proposals: a cross sectional study

Objective To explore the views of general practitioners (GPs) on the feasibility of collecting supporting information for the Royal College of General Practitioners (RCGP) revalidation portfolio and mapping of this evidence to the General Medical Practice framework for proposed UK medical re-licensing. Design Cross sectional study with a questionnaire. Setting One inner city and one mixed urban/rural primary care organisation in the West Midlands, England and one rural primary care organisation in Wales. Participants 51/69 GPs who submitted a revalidation portfolio from November 2009 to February 2010. Results The majority of GPs considered the majority of work based supporting information was feasible to collect within a 5 year revalidation cycle; most concerns were expressed about providing evidence for extended practice, learning credits, and patient satisfaction and colleague feedback surveys (59%, 63%, 72%, and 77%, respectively, of GPs considered it feasible to collect this evidence) due to workload time constraints and lack of automatic access to evidence from others, which differed by GP work role. Two-thirds of participants (65%) stated that the submission of a portfolio of evidence was a feasible component of GP revalidation, reporting reservations on the appropriateness of patient and colleague feedback surveys and extended practice (55%, 57%, and 59% respectively) to provide objective evidence. GPs requested further clarity on the evidence mapping process. Conclusion Overall, GPs reported a positive response to the RCGP revalidation proposals. Concerns were focused on collecting the newer types of supporting information and the ability of GPs non-principals to collect this evidence. GP revalidation training and preparation is required.     

2015—2018年重庆市毕业后全科医生教育开展情况研究

背景　全科医生是居民健康的“守门人”,建立健全全科医生培养制度,加强全科医生队伍建设,是医药卫生体制改革的重要部分。目的　深入分析2015—2018年重庆市毕业后全科医生教育开展情况,查找问题所在,提出建议。方法　收集重庆市55家全科培训基地2015—2018年全科医师规范化培训、助理全科医生培训参培人员年龄、学历、身份、持证情况、工作岗位等信息,分析培养规模和参培情况。结果　2015—2018年全科医师规范化培训,参培人员的学历以本科为主,占总人数的92.53%（1 486/1 606）,2018年本科生为95.24%（420/441）,较2015年的89.42%（321/359）增加5.82%;参培人员以应届毕业生和单位人为主,应届生占总人数的60%~70%,以农村订单定向培养学员为主,占80%左右。2016—2018年助理全科医生培训,参培人员的学历以专科为主,占总人数的98.99%（685/692）;参培人员中,应届毕业生占总人数的58.67%（406/692）。结论　目前重庆市毕业后全科医生教育存在助理全科医生培训启动晚且规模不足的问题;下一步应继续坚持开展临床医学专业（本科）农村订单定向医学生免费培养,沿用属地化免费医学专科生培训,同时尽快启动专科层次农村订单定向医学生免费培养,并适度扩大助理全科医生培训规模。     

西安地区2001～2003年高中毕业生乙肝病毒感染分析

目的:了解西安地区2001～2003年应届高中毕业生HBsAg阳性状况. 方法:采用ELISA法,对西安市部分城区和郊县农村应届高中毕业生19 142名进行血清HBsAg检测. 结果:总体阳性率3.76%. 男生阳性率显著高于女生(4.16% vs 3.29%,P<0.05);郊县农村学生阳性率显著高于城区(5.40% vs 1.61%,P<0.01);三个年度的阳性率依次分别为4.56%,3.70%和2.94%,差别非常显著(P<0.01),并且,各年度间的阳性率两两比较亦都有显著差别,2001年vs 2002年(P<0.05), 2001年vs 2003年(P<0.01),2002年vs 2003年(P<0.05),均有统计学差异. 结论:西安地区2001～2003年应届高中毕业生HBsAg阳性率为3.76%,并呈逐年下降趋势.     

How do Australian patients rate their general practitioner? A descriptive study using the General Practice Assessment Questionnaire

OBJECTIVE: To report patient responses to the General Practice Assessment Questionnaire (GPAQ) as a measure of satisfaction with health care received from Australian general practitioners. DESIGN, SETTING AND PARTICIPANTS: A clustered cross-sectional study involving general practice patients from 30 randomly selected general practices in Victoria. Between January and December 2005, a screening survey, including a postal version of the GPAQ, was mailed to 17 780 eligible patients. MAIN OUTCOME MEASURE: Scores on the six GPAQ items. RESULTS: We analysed data from 7130 patients who completed the screening survey and fulfilled our eligibility criteria. Levels of patient satisfaction with general practice care were generally high: mean GPAQ scores ranged from 68.6 (95% CI, 66.1-71.0) for satisfaction with access to the practice to 84.0 (95% CI, 82.2-85.4) for satisfaction with communication. Intracluster correlations for the GPAQ items ranged from 0.016 for overall satisfaction with the practice to 0.163 for satisfaction with access to the practice. Compared with national benchmarks in the United Kingdom, the GPs and practices participating in our study were rated higher on all six GPAQ items. Multivariable mixed effects linear regression showed that patients who were older, rated their health more highly, visited their GP more frequently and saw the same GP each time tended to express greater satisfaction with their care. CONCLUSION: Generally patients reported high levels of satisfaction with GP care. Greater satisfaction with care was associated with older patients, good health, more frequent contact with the GP, and seeing the one GP consistently.