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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 1.3 Health promotion and prevention of disease

Our practice provides health promotion and illness prevention services that are based on patient need and best available evidence.

Criterion 1.3.1

Health promotion and preventive care

Our practice provides health promotion, illness prevention and preventive care and a reminder system based on patient need and best available evidence.

Explanation

Key points

General practice as the gateway

General practices are the gateway to healthcare for most of the Australian population and are therefore well placed to play a key role in health promotion, illness prevention and preventive care. General practices also have the potential to coordinate with other health professionals and key agencies to achieve health promotion and preventive care objectives. The holistic approach to care that general practices provide, allows for each patient’s individual circumstances to be considered when providing health promotion, preventive care, early detection and intervention.

Health promotion is distinct from the education and information that GPs use to support their diagnosis and choice of treatment. Such prevention, education and health promotion may be delivered by GPs, general practice nurses or allied health professionals and reinforced through the use of written materials and other resources such as health promotion points in the ‘on-hold’ telephone messaging system or chronic disease self management/education clinics run by GPs or practice nurses.

Take home information

Education about health promotion and preventive care can be provided verbally during a consultation. It is also useful for patients to self select information on a range of health issues that may affect or interest them. The provision of written material is recommended as patients remember only three to four key messages from a consultation. This criterion refers to the many health pamphlets and brochures available from sources such as health departments, non-government organisations, health promotion programs, local community organisations and support and self help groups. Some educational materials are also produced in audio-visual format, which may complement the written material provided by the practice.

Aboriginal medical services often develop culturally appropriate material for their patients.

Practices are encouraged to be selective about the leaflets, brochures and pamphlets they make available, as these may vary considerably in quality and reliability.

Online information for patients

The use of the internet as a source of health information is becoming more common. Practices need to consider the quality of the information available on internet sites before recommending them to patients.

Practices are encouraged to use the checklist in the current edition of the RACGP ‘green book’ Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting to help determine whether patient education materials, including those on the internet, are of sufficient quality. The ‘green book’ is available at www.racgp.org.au/greenbook.

The HealthInsite website at www.healthinsite.gov.au is another useful resource and information is available in different languages.

A systematic approach to preventive care

Regular consultations are an opportunity for health promotion.

However, this criterion also requires practices to have a systematic approach to health promotion and preventive care for patients, including those with a physical or intellectual disability.

Systems may include patient prevention surveys, use of disease registers, recall and reminder systems and local service directories to assist with referrals to lifestyle modification programs.

Reminder systems need to operate in such a way as to protect the privacy and confidentiality of patient health information. Practices also need to consider their responsibility to their patients if the practice ceases using a reminder system.

Preventive activities need to be based on the best available evidence and where possible incorporate the use of clinical guidelines.

Health risk assessment

Health risk assessment is a key component of preventive care. General practitioners play an important role in the early detection of disease though screening programs such as the cervical and bowel cancer screening programs.

Managing patient information to support preventive care

Members of the clinical team routinely collect information that should be transferred to a patient’s health summary. A complete health summary makes a useful statement of the patient’s main health issues. This contributes to better continuity of care within the practice and when patients seek care in other settings.

Some information may also be transferred to national registers (eg. immunisation data) or state and territory based systems (eg. cervical screening or familial cancer registries) in order to improve care. Where the practice participates in national registers, patients should provide consent for the transfer of related health information to a register or be made aware that they can opt out of such registers. The RACGP new patient form is a useful tool for informing patients about national registers and recording a patient’s consent to the transfer of health information or their decision to opt out of a register. The new patient form can be ordered through RACGP publications.

Practices might also use data collected in the practice’s clinical software or paper based systems (eg. smoking status, diabetes register) to improve the targeting and use of prevention activities (eg. smoking cessation, weight management). They may use collected information transferred from private pathology providers (eg. diabetes screening, cervical screening). This is not only a quality improvement activity (see Criterion 3.1.1 Quality improvement activities); it also provides a check that the practice is identifying all relevant patients for their health promotion and preventive care activities.

Useful resources for the practice

Services providing care outside normal opening hours

The RACGP acknowledges that the provision of information by services that provide care outside normal opening hours about health promotion and illness prevention is likely to be opportunistic.

Standard 1.3 Health promotion and prevention of disease

Our practice provides health promotion and illness prevention services that are based on patient need and best available evidence.

Criterion 1.3.1

Health promotion and preventive care

Our practice provides health promotion, illness prevention and preventive care and a reminder system based on patient need and best available evidence.

In a nutshell

Criterion 1.3.1 has two aspects:

  • education and health promotion – this is generally about how your health service provides information and knowledge to patients, families and communities about achieving good health and preventing illness. It is also about current knowledge on managing chronic diseases such as diabetes.
  • 
a systematic approach to preventive healthcare – this is generally about how your health service puts systems in place to help you detect and manage patients’ health problems at the earliest possible stage.

This criterion is particularly important for Aboriginal community controlled health services in their efforts to achieve better preventive health outcomes for their communities.

Key team members

  • Health service manager
  • Clinical staff

Key organisational functions

  • Health promotion strategy
  • Preventive care strategy and systems
  • Early detection and intervention strategy and systems
  • Patient communication policies

Indicators and what they mean

There are no indicators for this criterion. However, because of its importance, it may be helpful for your health service to establish its own evidence or indicators for health promotion and preventive care activity. Some examples of evidence include:

  • the use of preventive health guidelines and resources, including those listed in Criterion 1.3.1 Health promotion and preventive care Useful resources for the practice
  • the use of decision support tools
  • an active recall and reminder system
  • up-to-date, plain language pamphlets and brochures
  • information on the website
  • a DVD library available for loan
  • preventive health activities, such as diabetic education groups or groups to help patients quit smoking
  • the contents of health records, showing health promotion and disease prevention activities
  • up-to-date health summaries
  • health promotions during NAIDOC Week and other planned community events.

Case study

Below is a description of the ways in which an Aboriginal Community Controlled Health Service can ensure effective health promotion and preventive care for its patients and community. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

The health service’s dietitian and Aboriginal health worker run a weekly cooking class that includes nutrition information, food preparation and healthy food choice education. They also run a fruit and vegetable program, where fruit and vegetable hampers are provided for families in conjunction with health checks, dental checks and hearing checks.

The service has effective systems in place for early detection of illness in its patients, and in the community as a whole. For patients it uses the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (2nd edition) to ensure it provides appropriate screening and preventive care. At the community level the service provides school health checks at a certain time every year, and relevant community-wide health screenings. It also uses information from data collected in its health records to target health promotion activities; for example, it uses its data on anaemia in children under 5 years old for its No Anaemia Day promotion.

Staff members use large mirrors mounted at child height for the health service’s trachoma prevention program. This program involves the children washing their faces and then checking in the mirror to see how ‘clean and shiny’ they are. It also gives staff members the opportunity to screen for skin infections as well as for trachoma symptoms.

Service dental staff run dental hygiene programs at local preschools and primary schools, and distribute dental ‘show bags’ with toothbrushes, toothpaste, stickers and handouts.

The health service participates in national, state or territory reminder systems and registers, such as the Australian Childhood Immunisation Register and the National Cervical Screening Program. Staff also participate in NAIDOC Week and community days, and provide health information to patients and community members. Awareness calendars about state health events are made available in the service, and health promotion events and activities are planned to coincide with state and national promotions.

Clinical staff use regular consultations as an opportunity for health promotion and preventive care. In addition, the service runs an active reminder system to encourage patients to have appointments for reviews, screening and health assessments.

The service ensures that patient health information collected by clinical staff is routinely documented in consultation notes and transferred to a complete patient health summary. Consequently its patient health files have comprehensive, up-to-date health summaries, which include information on health risk factors (such as smoking status, weight, height and alcohol consumption) as well as relevant social and family history. As a result, these files are a useful place to find information about a patient’s health status, and a resource in the early detection of illness or management of a chronic disease.

The service’s pathology providers send reports that summarise its diabetes and cervical screening activities and these are included in the patient health summaries.

Regular systems are in place as part of the health service’s early detection strategy. These include patient disease-prevention surveys, disease registers, recall and reminder systems, and local service directories.

The health service uses a system of flags or other reminders in patients’ electronic or paper-based records to assist it in identifying and/or targeting health promotion and prevention activities. In electronic records, this system triggers an alert when transferring to patient files information collected from private pathology providers – diabetes or cervical screening results, for example. In paper-based records, it could include general information about a patient’s smoking status.

The service uses easy and effective ways to educate patients about illness prevention. This includes providing up-to-date, take-home information such as brochures, pamphlets and other resources, all written in plain language. Patients then have an opportunity to read the information, understand it in their own time and accept the importance of taking action themselves.

The service also provides culturally appropriate information (written, visual and audio-visual) in the community languages of its culturally diverse patients. It ensures that clinical staff use appropriate resources during consultations – for example, they may be spoken or visual and include diagrams and simple language. In addition, the waiting room and consultation rooms have a wide range of current, culturally appropriate brochures and pamphlets available for patients.

The health service is selective in the information it makes available to its patients and community, including information on the internet sites it uses or recommends. It uses the checklist in the RACGP green book (see Criterion 1.3.1 Health promotion and preventive care of the Standards for general practices) and asks appropriate questions before sharing information or making recommendations. Appropriate questions include:

  • Is it well explained and clear?
  • 
Are there any culturally offensive materials attached?
  • Is the information accurate and reliable?
  • Does it apply to the local context?
  • 
Does it explain the importance of patients taking action themselves?

The service obtains the required consent when transferring patient information, such as immunisation or cervical screening data, to national registers or state- and territory-based systems. It informs patients of their right to opt out where it is available, using the RACGP’s new patient form, ordered via www.racgp.org.au/healthrecords

Related RACGP Standards and criteria

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