Trends in childhood illness and treatment in Australian general practice, 1971-2001.

OBJECTIVE To determine changes in morbidity and management of disease in children in Australian general practice. DESIGN AND SETTING A comparative study of general practice consultations in children under 15 years, using data from cross-sectional general practice surveys (1990-91 and 2000-01), and a descriptive comparison with a similar study from 1971. MAIN OUTCOME MEASURES Relative rates of management (rate/100 general practice encounters) of the most common children's problems and treatments. RESULTS Problems with significantly higher management rates in 2000-01 compared with 1990-91 included vaccination (11.1 v 7.6 per 100 encounters in 1990-91) and contact/allergic dermatitis (3.1 v 2.5). Those managed significantly less often in 2000-01 v 1990-91 included acute otitis media (7.7 v 9.4), asthma (5.4 v 8.8), tonsillitis (4.4 v 6.0), acute bronchitis (3.8 v 5.3) and gastroenteritis (1.7 v 2.7). Asthma management rates rose from 2.4% of all problems managed in 1971 to 7.2% in 1990-91, then fell in 2000-01 to 4.6%. More frequent rates of counselling and advice in 2000-01 (28.4% of encounters v 22.9% in 1990-91) were associated with a decrease in rates of prescribing and supply of medication (56.6% of encounters v 64.3% in 1990-91). Antibiotic prescribing declined significantly (from 33.8 per 100 encounters in 1990-91 to 25.2 in 2000-01), as did prescribing of respiratory medications (from 15.5 to 9.9 per 100 encounters), while prescribing of vaccines and systemic corticosteroids doubled (from 9.6 to 18.8 per 100 encounters, and from 0.6 to 1.2, respectively). (All comparisons between 1990-91 and 2000-01 are significant at P < 0.01.) CONCLUSIONS These findings point to the emergence of a generation of Australian children who are generally well vaccinated and are less likely to present to GPs with "traditional" childhood illnesses.