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Putting prevention into practice (Green Book)

Assessing and targeting priority groups and individuals for prevention

There is reliable information available regarding target populations for prevention activities and the additional risks faced by disadvantaged individuals, especially Aboriginal and Torres Strait Islander peoples. Access this information when planning and reviewing preventive activities and assessing level of risk.

An effective strategy is to ask patients to complete a ‘prevention survey’ in the waiting room before they see you. The time in the consultation is therefore better spent providing information, exploring concerns or negotiating for a separate appointment if the prevention issue is likely to take more time. As the time a patient waits to see the doctor is a significant predictor of their level of satisfaction, getting them to provide you with this important information while they wait is beneficial.

The Patient Practice Prevention Survey (see Appendix 4) can be completed by patients in less than 4 minutes and contains appropriate prevention activities indicated by current evidence. You may also wish to directly ask patients whether they have considered particular prevention activities.

A GP recommendation or brief advice in many prevention areas frequently helps to redress patient concerns and misperceptions. There are a number of reasons why patients do not take up prevention activities.

Immunisation

In children, failure to immunise is often related to forgetting, missed opportunities, intercurrent illness or false contraindications (eg. presence of a URTI). In adults and the elderly, it is often due to patients forgetting, concern about side effects or bad reactions, or misconceptions about a vaccine (eg. effectiveness, getting the illness from the vaccine).

Lifestyle changes (SNAP)

While most patients would agree that GPs have a role in assisting lifestyle change, they express considerable ambivalence about how GPs should approach this role. Many patients remain somewhat pessimistic about the potential impact of GP advice and would react if the GP offered advice regarding smoking cessation at every visit. Many smokers view seeking help or assistance as a sign of weakness or the need for a crutch. They believe they should be able to quit on their own, despite evidence to the contrary.141 A similar pattern emerges for patients who drink at hazardous levels. Both smoking and drinking are considered sensitive topics by both GPs and patients.

Pap tests

A number of factors influence the likelihood of an eligible woman to have a Pap test.142 Patients who have not had a recent Pap test are more likely to:

  • be older
  • come from a lower socioeconomic group
  • come from a non-English speaking background
  • attend a GP infrequently
  • have had a negative previous experience of a Pap test or are fearful or embarrassed about the procedure
  • have been sexually abused
  • be less convinced of the benefits of screening for cervical cancer
  • be fearful of developing cancer
  • not have had a reminder sent by the doctor
  • have not found time to have a Pap test or forgotten that one was due.

There are lower levels of Pap tests performed in eligible women if the GP:

  • is older
  • male
  • does not use a computerised or case note reminder system
  • does not send reminder letters to the patient
  • does not raise the issue.143

Mammography

A number of factors influence the likelihood of a woman having a mammogram.144
These include:

  • fear about the results of screening
  • convenience
  • belief that it is not needed
  • belief in the efficacy of mammography
  • absence of symptoms
  • a recommendation by the GP influences the likelihood that a woman will have a mammogram
  • discomfort or pain.

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