Your browser has 'Cookies' disabled, alert boxes will continue to appear without this feature.

Putting prevention into practice (Green Book)

Effectiveness

The 'gold standard' for evidence on which to plan preventive activities is the randomised controlled trial (RCT). In theory, this evidence tells us which interventions work and those that do not. However, because RCTs tend to have strict criteria they often exclude people with comorbidity and those who visit the GP infrequently. These latter features are more common in disadvantaged groups, so RCTs have limited applicability to the whole population. When considering disadvantaged communities, the guidelines on undertaking preventive activities may need to be supplemented with evidence about uptake and implementation. A GP recommendation or brief advice in many prevention areas is one of the most potent influences on both patient intentions and prevention related behaviour.

Resources

The average general practice consultation takes around 15 minutes therefore it is important to choose a strategy that is likely to be both effective and efficient. You can either adapt your preventive activities to the time available, or set aside time to mention prevention for all patients. The ‘reality pyramid’ approach may help with the latter option. Spending longer on an area is generally associated with a bigger impact, but in many situations, the result is not a linear effect. It is vital to be practical in assessing what you can achieve in the limited time frame of a consultation. However, you can still achieve a significant amount with brief interventions.

There is considerable evidence that for some patients, brief interventions for prevention, even 1 minute or less, can increase uptake and improve outcomes. Clear, brief nonjudgmental GP advice is effective in reducing hazardous drinking and smoking. A clear GP recommendation also results in a significant improvement in influenza vaccination rates, pneumococcal vaccination in the elderly, mammography and Pap test rates.

Systematically applied, brief interventions enable the GP to be better organised and targeted, further enhancing practice effectiveness. Spending just 1 minute on prevention with each patient provides greater opportunity to increase coverage of prevention to a greater proportion of patients. A crucial component of many interventions is referral to reputable and specialised services. Develop a resource directory based on positive patient feedback following their use of particular referral services. Where service provider choices are limited, the benefits of good partnerships and a multidisciplinary team approach are essential.156

The SNAP guideline and Lifescripts materials can help to frame lifestyle intervention strategies into activities that can be achieved in less than 1 minute, or in 1–5 minutes, using the 5A framework (Table 3).

Resources

 

Ask

Assess

Advise

Assist

Arrange

Smokers

Do you smoke?

Interest in quitting

Barriers to quitting

Nicotine dependence

Provide brief, nonjudgmental personalised and clear advice to aid quitting

Offer relevant pamphlets

Follow up or referral

Follow up soon after

Hazardous drinkers

Do you drink?

How much on a typical day?

How many days a week?

Concern about drinking

Interest in cutting down

Barriers to cutting down

Provide brief, personalised and nonjudgmental clear advice to cut down

Highlight other benefits of cutting down

Enlist support

Offer relevant pamphlets on safe drinking levels and ideas to help reduce intake Follow up soon after

Table 3. One minute interventions using the 5A framework for assisting smokers and hazardous drinkers

In thinking about interventions consider efficient and practical strategies.For example:

  • getting the patient to raise the issue of prevention. This may be achieved by using a patient questionnaire, posters, prompts and cues situated in the waiting room
  • being aware of the main barriers to prevention (see earlier discussion of barriers).GP recommendation is a potent influence on patient behaviour and practices
  • organising a clinic (eg. vaccination, chronic disease)
  • running a prevention group (eg. a ‘men’s health night’)
  • arranging outreach visits (eg. indigenous health visits)
  • planning separate consultations for longer intervention where appropriate. Many prevention activities and the assessment and management of chronic disease require considerable time. While screening may be performed during a consultation for another problem, it is useful to schedule a specific appointment for a more structured assessment. This is already supported by government incentives for conditions such as asthma and diabetes. However, it can be applied to smoking cessation, other lifestyle changes and many chronic conditions where follow up is advised
  • delegating or refering the task. There are also benefits to patients when appropriate referrals are offered during consultations. Some examples of prevention activities that may be referred to your PN include:
    • coordination of prevention activities
    • clinical information collection for the 75+ health assessment
    • coordinating the waiting room prevention questionnaire and entering the information into the computer
    • immunisation
    • chronic disease management (in conjunction with the GP), especially obtaining clinical information and routine investigations
    • lifestyle counselling (eg. smoking cessation)
    • health promotion and health education activities
    • patient follow up
    • the arranging of other support services
    • communication with others involved in a patient’s care.

Key messages

Discuss with staff

  • Make prevention activities routine and simple to sustain
  • Be systematic and use a ‘whole of practice’ approach. Plan what you need to do
  • Implement strategies that are transparent, respectful and congruent with the goals of patients, GPs and your practice staff
  • Measure and reflect on successes and failures

SEARCH THIS GUIDELINE

Advertisement

The Royal Australian College of General Practitioners

Contact Us

General Inquiries

General Enquiries

Opening hours 8:00 am-8:00 pm AEST

1800 4RACGP

1800 472 247 | +61 (3) 8699 0300 (international)

Payments

Payments

Pay invoices online

RACGP automated payment service: 1800 198 586

Follow us on

Follow RACGP on Twitter Follow RACGP on Facebook Follow RACGP on LinkedIn


Healthy Profession. Healthy Australia Logo

The Royal Australian College of General Practitioners (RACGP) ABN 34 000 223 807
RACGP House, 100 Wellington Parade, East Melbourne, Victoria 3002 Australia

Terms and conditions | Privacy statement
Sponsor conditions | Delegate conditions