Foot, ankle, and leg problems in Australian primary care: consultation patterns, management practices and costs

Background: Foot ankle, and leg problems are highly prevalent in the general population. The objective of this study was to explore consultation patterns, management practices and costs of foot, ankle, and leg problems in Australian primary care. Methods: We analysed encounter data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016 inclusive. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS clinical terminology. Data were summarised using descriptive statistics and 95% confidence intervals around point estimates, and multivariate logistic regression was used to determine general practitioner (GP) and patient characteristics independently associated with a foot, ankle or leg problem being managed at an encounter. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule, and for non-prescribed medications, large banner discount pharmacy prices were used. Results: GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle or leg problems were managed at a rate of 3.24 (95% CIs 3.21 to 3.28) per 100 encounters. The management rate per head of population increased by 34% between 2000 and 2016. Management of a foot, ankle or leg problem was independently associated with patient characteristics (increased age, having a health care card, and being English-speaking) and GP characteristics (male sex, younger age, and Australian graduate). The most frequently used management practice was the use of medications, followed by procedures/physical medicine and imaging. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m. Of this total cost, MBS items comprised $139m, followed by imaging (A$69m), medications (A$29m) and pathology (A$18m). Conclusions: Foot, ankle and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.