Coordination issues in the consultation arise where:
- patient care is shared between the GP and PN or others external to the practice
- patients have complex health issues.139,140
Effective coordination requires:
- good communication between the parties, including adequate referral mechanisms and documentation
- a clear plan with clarification of roles and responsibilities.
The SNAP guideline provides examples of plans that assist patients to make changes in their behaviour. Encouragement of self management of chronic disease also involves a planning process.
NSW trial of SNAP implementation
A project to develop and evaluate a model of an integrated approach to management of the four behavioural risk factors in general practice was trialled in two New South Wales' divisions of general practice. The intervention included practically orientated clinical training for GPs and nurses in SNAP, behaviour change and motivational interviewing, provision of the SNAP guideline and patient education materials, training of practice staff to set up recall and reminder systems, visits to each practice within the division to determine practice needs and support, and liaison with external stakeholders. While a number of barriers to implementation remained at the end of the trial, GPs reported significantly increased confidence in their ability to assess the stage of change of patients and to do this more often, and increased confidence in using motivational interviewing techniques. Many practices established registers for patients with chronic diseases and patient education materials were more commonly provided.
Colletta Hobbs, University of New South Wales, New South Wales sphcm.med.unsw.edu.au
- The SNAP guideline links a series of common risk factors (including obesity, high blood pressure, physical inactivity, poor nutrition, raised blood cholesterol, alcohol abuse and tobacco smoking) with largely preventable chronic diseases (including CVD, type 2 diabetes, osteoarthritis and osteoporosis, asthma, and emphysema) at www.racgp.org.au/guidelines/snap