Guidelines for the implementation of prevention in the general practice setting

The Green Book
1.3 Bringing prevention and implementation together 
☰ Table of contents

A quality improvement (QI) approach

Implementing preventive activities in your practice is an aspect of a broader QI approach. Implementing a QI approach to prevention usually involves several elements:

  • broadening of focus from just thinking of care of the individual to actively reflecting on the larger population18,19
  • planning for change20
  • promoting a culture of QI in the practice team21–23
  • a collaborative team approach to prevention24-30
  • a realistic framework for implementation31
  • being outcomes-focused23,32
  • acknowledging the context and complexity of general practice33–42
  • choosing implementation strategies that are evidence-based, efficient and ‘do-able’ in general practice.43,44
 
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Preventive care is part of a broader QI approach.


Alignment with other QI frameworks

Quadruple Aim

Implementing preventive care aligns with the Quadruple Aim framework for delivery of high-quality care, which has the goals of:45–47

  • improving the individual experience of care
  • improving the health of populations
  • reducing the per capita cost of healthcare
  • improving the experience of providing care.


Achieving these goals and successful implementation of prevention both require an engaged and resourced team, as well as effective and collaborative organisations.47

Patient-centred medical home

Although preventive care tends to have a population focus, it still aligns with the patient-centred medical home (Medical Home) model, which has five elements:48,49

  • comprehensive care
  • patient-centred care
  • coordinated care
  • accessible services
  • focus on quality and safety.

A successful Medical Home will provide high-quality preventive care to its patient population (refer to the RACGP’s
Standards for patient-centred medical homes, Standard 4: Comprehensive preventive, acute and chronic disease care).

 
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To help practices implement a Medical Home approach, the North Coast PHN has created a website with resources such as videos and print materials, including the Patient centred medical home: A quality improvement handbook for general practice.
The Green Book



 
 
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  2. American College of Preventive Medicine. Preventive medicine. Washington, DC: ACPM, [date unknown].  [Accessed 2 March 2018].
  3. Gelly J, Le Bel J, Aubin-Auger I, et al. Profile of French general practitioners providing opportunistic primary preventive care – An observational cross-sectional multicentre study. Fam Pract 2014;31(4):445–52.
  4. Drewes YM, Koenen JM, de Ruijter W, et al. GPs’ perspectives on preventive care for older people: A focus group study. Br J Gen Pract 2012;62(604):e765–72.
  5. The Association of Faculties of Medicine of Canada. Chapter 4: Basic concepts in prevention, surveillance, and health promotion. In: AFMC. AFMC primer on population health: A virtual textbook on public health concepts for clinicians. Canada: AFMC, updated 2017. [Accessed 2 March 2018].
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  7. Wagner H. Quaternary prevention and the challenges to develop a good practice comment on 'Quaternary prevention, an answer of family doctors to overmedicalization'. Int J Health Policy Manag 2015;4(8):557–58.
  8. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016.
  9. Glasgow RE, Vinson C, Chambers D, Khoury MJ, Kaplan RM, Hunter C. National Institutes of Health approaches to dissemination and implementation science: Current and future directions. Am J Public Health 2012;102(7):1274–81.
  10. National Collaborating Centre for Methods and Tools. Implementing best practice guidelines: The RNAO toolkit. Hamilton, ON: McMaster University, updated 2017. [Accessed 2 March 2018].
  11. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 2012;7:37.
  12. Eccles MP, Hrisos S, Francis JJ, et al. Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study. Implement Sci 2011;6:61.
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  16. Zwar NA, Richmond RL, Halcomb EJ, et al. Quit in general practice: A cluster randomized trial of enhanced in-practice support for smoking cessation. Fam Pract 2015;32(2):173–80.
  17. Halcomb EJ, Furler JS, Hermiz OS, et al. Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: Views of general practitioners and practice nurses. Fam Pract 2015;32(4):468–73.
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  21. Verbakel NJ, de Bont AA, Verheij TJ, Wagner C, Zwart DL. Improving patient safety culture in general practice: An interview study. Br J Gen Pract 2015;65(641):e822–28.
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  32. Agency for Healthcare Research and Quality. National strategy for quality improvement in health care. Rockville, MD: AHRQ, updated 2016. [Accessed 2 March 2018].
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  34. Salisbury C, Procter S, Stewart K, et al. The content of general practice consultations: Cross-sectional study based on video recordings. Br J Gen Pract 2013;63(616):e751–59.
  35. Booth BJ, Zwar N, Harris MF. Healthcare improvement as planned system change or complex responsive processes? A longitudinal case study in general practice. BMC Fam Pract 2013;14:51.
  36. Lau R, Stevenson F, Ong BN, et al. Achieving change in primary care – Causes of the evidence to practice gap: Systematic reviews of reviews. Implement Sci 2016;11:40.
  37. Leeman J, Calancie L, Hartman MA, et al. What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: A systematic review. Implement Sci 2015;10:80.
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