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Putting prevention into practice (Green Book)

Principles

  • The approach to the implementation of preventive care should be systematic and whole of practice orientated.157–159 This involves a shift in perspective for many practitioners who are used to focusing on individual patients and their needs
  • Attempts should be made to identify and address health inequalities and disadvantage
  • By participation in multidisciplinary teams general practice has overcome barriers in providing high quality preventive care in areas of significant disadvantage. Linking patients with welfare services to ensure they maximised their access to available benefits has been found to be a useful approach to addressing disadvantage in the general practice setting
  • Implementation strategies should be evidence based and outcomes focused 160–162
  • Approach should be realistic, feasible, transparent and congruent with the goals and philosophy of the practice and practice staff.

Implementation of prevention activity should respect the context and complexity of general practice. Improvement of care is not necessarily improved by the removal of variability. A strategic approach will make allowance for local knowledge of the context and issues.

The process should address both short and long term implementation issues. Much effort is expended in setting up programs and activities without paying attention to sustainability. Factors associated with practice routine include:

  • organisational memory – reflects the shared interpretations of past experiences that are relevant to current activities (includes social networks, paper based manuals and computerised memory)
  • adaptation – implementation strategies need to be adapted to local context and circumstances (such a process also facilitates engagement and ownership)
  • values – the program should reflect the collective values and beliefs of the practice.

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