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Putting prevention into practice (Green Book)

Alternative ways of delivering prevention activities

Clinics

Clinics may focus on a specific problem or a target group and may save the GP time by involving the PN. Think about whether you have the necessary resources and the return on effort. Evidence suggests that clinics have a positive impact on vaccination, Pap tests, and provision of care to the elderly and other groups. The effectiveness of clinics has been unclear in the management of some conditions such as asthma, and may have higher cost with outcomes that are only equivalent to hospital based clinics. There may also be an inefficient use of specialist resources and problems with time and practicality.

Before you decide to set up a clinic, investigate what other practices are doing, what has worked well, and what assistance your division of general practice can offer. Assess the likely costs and benefits. If you work in conjunction with an Aboriginal health service or a youth group, you might be able to access hard to reach patients.

Exercise enablers

A division of general practice organised training for interested people to become ‘exercise enablers’, using the Active Script model. GPs could then refer patients to the exercise enabler. Similar strategies have been developed in other divisions for other health conditions (eg. shopping tours for patients with weight problems). One practice even trained an instructor in Tai Chi, who in turn offered sessions to patients.

Rob Grenfell, West Vic Division of General Practice, Victoria www.westvicdiv.asn.au

Recruiting other health care practitioners/lay health workers

A lay health worker has been defined as ‘any health worker carrying out functions related to health care delivery; trained in some way in the context of the intervention; and having no formal professional or paraprofessional certificated or degreed tertiary education’. The diversity of studies and settings have made it difficult to confidently assess their impact except in certain situations (eg. immunisation and promotion of breastfeeding).

Collaborative care

Partnerships with other health care professionals may increase support for the GP, thereby increasing the quality of care of patients. Collaboratives are a more involved process with an emerging track record of health improvements.

Resource

Working together for better mental health

Improved access to allied health services was identified as one component of the Better Outcomes in Mental Health Initiative. The co-location of allied health professionals (including psychologists, social workers, mentalhealth nurses, occupational therapists, Aboriginal health workers) within the general practice was piloted as a model of service delivery. Benefits expressed by GPs included increased confidence in managing mental illness knowing a system of support is available and accessible, and improved knowledge sharing leading to early intervention and prevention of the development of more serious mental illness. Allied health professionals reported improved collaboration and shared care with GPs and improved provision of continuity of care. Patients reported less stigma attending the practice, costs are kept minimal and affordable, and improved coordination in the management of mental health conditions.

Fremantle Regional GP Network, Western Australia www.frdgp.com.au

Patient group sessions

One way to increase the effectiveness of a patient session and minimise the time spent by the practice is to invite community groups or organisations to provide sessions for patients. Group sessions have been found to be effective for smoking cessation, diabetes, and minimising illicit drug use. It might be useful to hold the first session with practice staff as the audience if the provider is not already known to your practice. Examples include a diabetes clinic held by the GP and PN, along with the relevant state or territory Diabetes Association, or an information session for patients with cancer run by a local self help group.

‘Afternoon tea with my GP’ – An innovative model for group education and health promotion

Over 6 years ago, a division of general practice began running ‘Afternoon tea with my GP’ sessions on a Saturday afternoon in practice waiting rooms. Since that time, education sessions in line with the seven National Health Priority Areas have been delivered. In addition, the division has collaborated with organisations such as BreastScreen and the National Heart Foundation to offer sessions on specific topics such as: ‘Are you at risk for diabetes?’, ‘Taking steps to improve your heart health’, ‘Women’s midlife health issues’, ‘Seniors’ physical activity’, ‘Children’s preventive health’, ‘Asthma management’ and ‘Myths surrounding breast cancer’. This model provides a flexible way to deliver health messages to groups of patients in an interactive and cost effective manner. The nonthreatening and familiar venue of the GP’s waiting room combined with the relaxed and interactive nature of the session encourages patients to return to their GP for further information. The division coordinates the sessions and arranges advertising. This model not only facilitates networking and collaboration between general practices and allied health, but also promotes the role of PNs as health educators.

Fremantle Regional GP Network, Western Australia www.frdgp.com.au

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