Green Book

Putting prevention into practice - Chapter 4.2

Principles

Key points

The PRACTICE framework:

  • Is useful when implementing preventive activities – it incorporates elements of several other theories and frameworks
  • Helps identify and overcome barriers to implementation (eg engagement, collaboration and systems)
  • Helps remind us that change is incremental and that we should plan for and recognise ‘small’ successes along the way.

The Green Book brings together two main themes: prevention and implementation.

Both of these sit within QI and are inherently associated with behaviour change.

When planning preventive interventions, start by collaborating with your practice team to establish a set of principles that will guide your team through the improvement process. We have looked at the general principles of putting prevention into practice in chapters 1–3. To recap, they are:

  • broadening our focus from the individual to the group or population
  • having a practice culture that values and promotes quality improvement (and is open to the change needed to achieve it)
  • working collaboratively on all levels (patient–practice team; within the practice team; practice team–other supportive organisations)
  • having a realistic plan
  • using implementation strategies with good evidence of effectiveness (detailed in this chapter).​

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This is a great opportunity to do a proper analysis and develop a plan:

  • Look at your practice population: What’s the overall picture?
  • In terms of what you do, where are the gaps?
  • What are your priorities?
  • Instead of assuming that you do some things well, look at the data and work out ways to improve.

– Assoc Prof Charlotte Hespe, Green Book Editorial Committee


One of the early steps in improving preventive care is identifying a target or a ‘problem to be solved’.

This may be a population/group (eg smokers, risky drinkers) or an intervention (eg immunisation, screening). Tools that can help you identify a target include:


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Sometimes a sentinel event can be a trigger for quality improvement.

For example, in late 2016, a thunderstorm asthma event occurred in Victoria, resulting in many thousands of people experiencing breathing difficulties, widespread health service use and even deaths. This triggered many practices to implement preventive activities focused on ensuring their asthmatic patients were receiving the best possible care.

– Prof Danielle Mazza, Green Book Editorial Committee


To work out what needs to change, you need to analyse the gap between current practice and evidence-based best practice. This gap analysis will also provide you with a way of measuring progress.

It is important to be clear about the behaviours that need to be changed, any relevant contextual changes that also need to be made, and the level at which the intervention will be delivered (individual, whole of practice or practice population, or community).


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Working together for better health outcomes for our patients

Having high-quality data is in everyone’s best interest. There is no better way to facilitate the active management of a practice population, particularly for those at high risk. We have a whole-of-practice, proactive and continuous approach to data quality. Our clinical team values the practice team’s quality improvement efforts as it helps them manage their patients in a more optimal way.

First, we ensure that the information collected from patients is relevant, complete and recorded correctly. Second, we identify gaps in our data and have strategies to remedy them. Throughout this process, we communicate our goals and track our progress with the team.

An example of this is our diabetes program, which stemmed from a diabetic audit – we now have 65% of our patients with HbA1c <7% which is an excellent result. These wins remind us that the numbers are not ‘just data’, these are our patients – our community – and we are working together for better health.

– Ms Kylie Gibson, Practice Manager, Fisher and Holder Family Practice ACT


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General practice case study

Staff at a practice identified overweight and obesity as a problem they wanted to tackle (67% of patients aged >40 years were overweight and obese).

But the practice GPs felt frustrated in supporting patients to lose weight – their patients rarely took on or adhered to preventive advice. Patient health literacy was identified as a problem; the GPs agreed that many of their patients did not fully understand how much they should be eating or how to go about exercising.

At a staff meeting, each staff member contributed to the discussion regarding the issues faced. The PN was interested in being more involved in weight management but lacked sufficient time to take patients through a structured program involving multiple sessions.

So, the following strategy was devised: As overweight and obese patients were identified by the GPs, they were offered an appointment with the PN for a health check, which involved some brief education and goal-setting. The PN then assisted the patients to register for free telephone weight management coaching provided by the state health department. The PN then followed patients up after a few weeks to determine if they found it helpful and what progress they were making.

– Prof Mark Harris, Green Book Editorial Committee


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