Guidelines for the implementation of prevention in the general practice setting


The Green Book
5.2 Creating an environment that supports prevention 
☰ Table of contents


The practice’s digital environment


Practice website

Your practice website can also be used for patient education. All resources created should be made available online. Where possible, this information should be available in patients’ preferred language.

Box 4. Tips for setting up a high-quality website

  • Ensure that any recommended activities or interventions are supported by evidence
  • Have a policy of regularly reviewing the material
  • Provide links to reputable sources of information
  • Survey your patients to see what information they would like to access
  • Consider using the practice website for making appointments
  • Include some useful preventive care or other tools (eg prevention survey) on the website2

An increasing amount of information and educational materials is available online. Many patients will have previously accessed this information, or will do so after visiting the practice. It is therefore important your practice website features other recommended websites that provide unbiased and evidence-based information.

The Victorian Department of Health’s Better Health Channel is a good example of a useful online resource. You may consider placing this on your own website, together with some other credible health information website links, such as:

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Find out more about making the best use of your general practice website 

 

Mobile health, including smartphone apps

Mobile health (mHealth) is a general term for the use of mobile phones and other wireless technology in medical care. Text messaging interventions have the advantages of tailoring, interactivity, personalisation and high message repetition.

The most common application of mHealth is the use of mobile phones and other communication devices to educate consumers about preventive healthcare services. However, mHealth is also used for disease surveillance, treatment support, epidemic outbreak tracking and chronic disease management.

Smartphone apps can be used to:

  • provide information
  • provide prompts
  • record information (eg diet, exercise, blood glucose levels, sleep)
  • provide support and connect with others (eg smoking cessation apps often have a buddy system).

It can be difficult to gauge the quality of apps before recommending them to patients. Many of the interventions have no long-term data, and evidence of effectiveness, while generally positive, is mixed.5–18 The RACGP has a number of resources on what to look for in an app:

Your PHN is another source for apps for health. The UK’s National Health Service (NHS) also has an app library.

 
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I recently learnt about the Couch to 5K podcast series from a UK colleague. This series of podcasts developed by the NHS is played on your phone and guides you through a half-hour exercise program that over nine weeks takes you from being sedentary on the couch to running 5 km. Cheaper than a personal trainer, I have recommended it to many of my patients.

– Prof Danielle Mazza, Green Book Editorial Committee

 

Practice newsletter

A practice newsletter may be a useful way of informing patients about preventive issues. You may distribute this via email, social media or on your website.
 

The waiting room


Waiting room materials

The waiting room can be an important place for patients to access health information.19,20 Materials such as posters and leaflets are often available from health promotion units of state health departments, your primary care organisation and non-government organisations such as the Heart Foundation, Diabetes Australia, Cancer Council, Quit and other peak bodies.

The effectiveness of these materials is debatable. Generally, a more targeted and personalised approach to providing health information is considered more effective.

Where posters and leaflets are used, the information should be clear, simple, engaging, timely (eg for influenza season, Movember) and unbiased. If possible, it should be available in the languages used by patients attending the practice. Materials need to be replenished and rotated regularly. A poster that is left in the practice for years will become all but invisible.

A ‘less is more strategy’ should also be used. Much of the material on noticeboards is not readable unless the patient walks up to it. Most patients won’t do this. Sensitive material may be better portrayed in more discreet locations (eg sexually transmitted infection advice on the back of the toilet door).

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Two pieces of advice:

  • Check the validity of materials and regularly update.
  • Showcase a topic of the month – use the Department of Health Calendar of Events to pick your health topics.

- Ms Jan Chaffey, Green Book Editorial Committee

 
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If you have a TV in the waiting room and you’re just playing daytime TV shows, you’re missing an opportunity to provide useful information to patients. There are specialised video materials available for waiting rooms. These can both entertain and inform.

You can also have your own material (eg presentation slides) incorporated into these videos.

- Ms Karen Booth, Green Book Editorial Committee

 
 
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Patient education is more effective when personalised and handed out to the patient by the GP or practice staff.

– Assoc Prof John Litt, Green Book Editorial Committee

 

Note: you can also provide information in different formats – for example, you can email information to the patient and provide links to useful websites.

 

A practice notice board can provide information about self-help groups and local programs, as well as contact information for patients to self-refer. It is important to keep the notice board up to date. Some practices now provide computers in the waiting room that allow patients to access education material from selected websites.

NPS MedicineWise also has a MedicineWise handbook, which is a consumer resource designed to be read by patients in waiting rooms. It defines health and medical terms and offers summaries on each page.

Aboriginal medical services often develop culturally appropriate material for their patients. Visit the Australian Institute of Family Studies’ Key Aboriginal and Torres Strait Islander organisations for a list of useful contacts.


The staff room


The staff room is an under-used area for messaging to and engaging staff. You should have a chart in your practice staff room showing your progress with the prevention intervention activity and achievements to date.

 

The reception area


It is worthwhile highlighting to the practice reception staff that they are an essential part of the healthcare team. Through their various activities they influence healthcare outcomes, not just administrative aspects. Examples includes their roles in prompting patients, checking reminder systems, assembling practice registers and refreshing the waiting room.
Reception staff can be involved in prevention in a multitude of ways, such as:

You can also provide health information (such as on influenza shot programs and health checks) for patients on hold on the telephone. Be sure to review this in a timely fashion to ensure the relevance of the information being provided.
 

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Using waiting time for prevention

While waiting for their appointment, patients can fill out a brief questionnaire to identify SNAP risk factors and to assess thoughts about change.
For example:

  • Do you smoke tobacco?
  • How do you feel about your smoking at the moment?
  • Are you ready to stop smoking now?
  • How confident do you feel about your ability to stop smoking?

For more information, refer to the RACGP's SNAP guide and Supporting smoking cessation: A guide for health professionals.
Also refer to the RACGP’s Clinical indicators for Australian general practice: 6. Screening for smoking status; and 7. Screening for alcohol consumption.

 

The consulting room


Patient education materials

Patient education materials handed directly to patients by the GP or PN can have significant impact. These should ideally be stored on computers used in the consulting rooms. The quality of the materials should be checked.21 Consider the currency and sources of information, as well as their reliability, relevance and accuracy.
These materials should be tailored to the patient’s:

  • language (and be culturally appropriate)
  • health problems (eg existing CVD)
  • interest and willingness to change.
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It’s important to check a patient’s level of understanding of the information provided. Generally speaking, written information should be at a reading age of eight years (the reading age of a newspaper such as the Herald Sun is 12 years).

– Prof Mark Harris, Green Book Editorial Committee

 

Consider a variety of resources to cater for differing levels of literacy and health literacy among the groups attending your practice. These materials should also be evidence-based and provide a balanced approach to the problem.

State health departments often have multilingual patient education materials available for download or for purchase. Check with your local state or territory health departments for multilingual resources and referral centres available to your area.

NPS MedicineWise offers a range of materials in hard copy, online and via a smartphone app. These help patients better manage their medicines and learn about how lifestyle choices directly affect health, as well as how they can help prevent ill health.

 

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Another useful strategy for the practice to consider is the ‘walking interview’.

This involves accompanying a patient who is unfamiliar with the practice as they experience booking an appointment, registration and waiting to be seen.
Staff should obtain feedback from patients.
This can be useful for a number of patient groups such as people from CALD backgrounds, Aboriginal and Torres Strait Islander background and patients with a disability. It helps to determine the relevance and accessibility of practice information and systems, and where changes are required.

– Prof Mark Harris, Green Book Editorial Committee

 
 
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On your bike

One GP in our clinic rode to work. He parked his bicycle in the consulting room, unashamedly. In doing this, he acted as a passive role model and provided a conversation piece, with some patients asking about the bike.
‘Yes, I ride my bike in to work. Do you know it’s hardly any longer than by car, and incidental exercise like this has proven benefits for people like you and me – even folk with chronic disease?’
‘Yes, bike riding is a little more dangerous. But there is some evidence that the exercise benefits outweigh those risks: you’re actually better off riding than driving!’

– Professor Chris Del Mar, Faculty of Health Science and Medicine, Bond University, Queensland

The Green Book



 
 
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