Green Book

Introduction

Focusing on prevention is an important response to Australia’s increasing healthcare needs.

In general practice, we are well trained and skilled in caring for, and working alongside, patients who present with multiple issues and health-related problems. What we don’t do often is step back from the individual before us and consider our patients as a community or population. Yet this shift in focus holds enormous potential to improve health outcomes. While we continue supporting individuals to take greater responsibility for their health and prevent illness, if we also work at a practice population level, we have opportunities to affect the broader determinants of health and illness.

Improving preventive care for individuals and communities leads to better health.1 To this end, multiple evidence based recommendations have been developed. The Guidelines for preventive activities in general practice, ninth edition (Red Book) is a key source of these. However, when we look across general practice, implementation and delivery of preventive services is variable.2,3

It is not our medical knowledge that can adversely affect our ability to deliver preventive care. Rather, it is our ability to recognise and overcome a combination of individual factors (eg time pressures, competing demands, skill levels, attitudes) and practice systems and organisational factors (eg availability of a team, clarity of roles, lack of resources, a culture focusing on treatment rather than prevention). Putting preventive recommendations into practice requires knowledge in areas we are not well taught, such as implementation science, change management, organisational behaviour, and data collection and analysis.

In Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting (Green Book), we aim to give you enough useful knowledge in the above areas to create a clear and actionable plan to improve your practice’s preventive care.

Since 1998, The Royal Australian College of General Practitioners (RACGP) has published the Green Book to support evidence-based preventive activities in primary care.

The Green Book is designed to help you put preventive care recommendations from best practice guidelines into practice. It provides case studies to reflect on and contains advice about practical processes, strategies and tools for implementing and sustaining preventive activities.

The Green Book brings together the evidence and the lessons learned from the literature and from real-life general practice experiences to make implementation of preventive activities as straightforward and effective as possible.

These lessons include:

  • Simply disseminating guidelines within your practice is not enough to change practice
  • Using a practical framework that is guided by theory can improve success
  • Implementing all recommendations from evidence-based guidelines may be unrealistic and unachievable – what you chose to implement depends on your practice context (ie established need, clinician preference, complexity, capacity/capability and resources available)
  • Improving implementation depends on changing multiple behaviours of multiple people (ie healthcare professions, practice managers, administrators)
  • Implementation efforts are more likely to be successful if you have strong organisational leadership and wholeof-practice engagement
  • You need to set goals that you can measure

By aligning leadership, building capacity for change, creating a culture of quality improvement (QI), and selectively choosing the relevant processes needing change, general practices can organise their environment to successfully deliver preventive services.4

You can think of the Green Book as a practical companion to the RACGP's Red Book. However, it also works to support the implementation of other RACGP publications such as Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factors in general practice, second edition, and the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, third edition (National Guide) (Figure 1).

The Green Book is also a resource to help your practice meet the RACGP Standards for general practices, fifth edition  (the Standards).

Figure 1. How the Green Book fits with other RACGP publications

Figure 1

How the Green Book fits with other RACGP publications

As an interdisciplinary approach to prevention is typically more likely to be successful,5 the Green Book is a central resource for your whole practice and for those working with your practice, including:

  • members of the practice team involved in or interested in QI
  • members of practice teams responsible for implementing evidence-based guidelines
  • practice management decision-makers
  • groups working with general practices to improve Australian healthcare, such as Primary Health Networks (PHNs), particulary QI support officers
  • peak bodies (eg Consumers Health Forum, Diabetes AustraliaCancer AustraliaHeart Foundation)
  • allied health professionals

It may also be useful for patients and carers.

Throughout the green book, you will find symbols that signal the type of information presented.

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Where you see this symbol...
The information relates to...
General practice - a whole-of-practice approach

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​The information relates to...
External organisations (PHNs, peak bodies)

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A practice management point

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Where you see this symbol...
​The information relates to...
A clinical point

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​The information relates to...
An idea you could use in general practice

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A case study from one of our contributors

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Where you see this symbol...
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An experience from general practice

  1. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016.
  2. Geense WW, van de Glind IM, Visscher TL, van Achterberg T. Barriers, facilitators and attitudes influencing health promotion activities in general practice: An explorative pilot study. BMC Fam Pract 2013;14:20.
  3. Grunfeld E, Manca D, Moineddin R, et al. Improving chronic disease prevention and screening in primary care: Results of the BETTER pragmatic cluster randomized controlled trial. BMC Fam Pract 2013;14:175.
  4. Knierim KE, Fernald DH, Staton EW, Nease DE Jr. Organizing your practice for screening and secondary prevention among adults. Prim Care 2014;41(2):163–83.
  5. Registered Nurses’ Association of Ontario. Toolkit: Implementation of best practice guidelines. 2nd edn. Toronto: RNAO, 2012.