Relationship between general practitioner certification and characteristics of care

Area of Science:

• General Practice and Primary Care
• Health Services Research
• Medical Education and Professional Standards

Background:

• Mandatory or quasi-mandatory certification for general/family doctors is increasingly common globally, including Australia.
• The impact of such certification processes on the quality of patient care remains under-investigated.

Purpose of the Study:

• To investigate the association between vocational certification of general practitioners (GPs) and their clinical performance in Australia.
• To determine if physician certification influences patient care and management practices.

Main Methods:

• Secondary analysis of a national cross-sectional survey data from Australian general practitioners (GPs) conducted between April 2000 and March 2002.
• Inclusion of a random sample of 1982 GPs, with data collected on 100 consecutive patient encounters per participant (total 197,500 encounters).
• Comparative analysis of characteristics of certified versus uncertified GPs, their patients, and management actions, testing 34 performance indicators.

Main Results:

• Vocationally certified GPs (33.4%) differed significantly from uncertified peers in demographics, practice characteristics, and computer use.
• Certified GPs had longer consultations, performed more therapeutic procedures, prescribed fewer medications (notably NSAIDs in elderly and antibiotics for URTI), and utilized more diagnostic and referral services.
• After adjusting for confounding factors, significant differences in consultation behavior and patient management persisted.

Conclusions:

• Vocational certification for general practitioners is significantly associated with distinct patterns of consultation behavior and patient management.
• These findings suggest that certification influences how GPs practice medicine and manage patient care.