Guidelines for the implementation of prevention in the general practice setting


The Green Book
2. Whole-of-practice prevention
☰ Table of contents


Key points

 

  • Prevention requires consideration of practice populations (without taking away from individual care)
    • – high-quality data is important in obtaining useful information.
  • Every member of the practice team plays a role in preventive care.
  • Your preventive care team will also include people outside your practice (eg PHN QI support officers, allied healthcare providers, disease and consumer peak bodies).


While few would disagree that prevention is an important part of high-quality, comprehensive healthcare, much of the healthcare system (including general practice) is focused on reactive care.

Although we can intuitively see how prevention can reduce the need for reactive treatment, it can be difficult to change focus when the demand for treatment is so much ‘louder’, more urgent and resource hungry compared to preventive care.

 
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When you’re up to your neck in alligators it is hard to think about draining the swamp.

– Assoc Prof John Litt, Green Book Editorial Committee


In this section of the Green Book, we will look at how we can broaden our focus to incorporate prevention without detracting from the quality of reactive care. The key elements of this shift are:

  • having a comprehensive understanding of your practice population (so that you can target preventive activities and resources to their needs)
  • involving all members of the practice team in preventive care (sharing the workload and responsibility)
  • collaborating with external groups and support services.

Effective prevention requires partnership and collaboration on multiple levels – that is, between:

  • the patient and GP
  • the patient and practice team
  • the GP and practice team
  • the GP and allied healthcare professionals
  • the practice team and PHNs and/or the broader community and health system.
 
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If you want to improve the quality of prevention in your practice, your whole practice needs to be involved.
Think about the roles of the individual members of the practice team and what contribution they can make towards preventive care.

– Prof Mark Harris, Green Book Editorial Committee

 
The Green Book



 
 
  1. Nutbeam D. Building health literacy in Australia. Med J Aust 2009;191(10):525–26.
  2. von Wagner C, Steptoe A, Wolf MS, Wardle J.Health literacy and health actions: A review and a framework from health psychology. Health Educ Behav 2009;36(5):860–77.
  3. Agency for Healthcare Research and Quality. Practice facilitation handbook. Module 14. Creating quality improvement teams and QI plans. Rockville, MD: AHRQ, updated 2013.  [Accessed 2 March 2018].
  4. Dawda P, Jenkins R, Varnam R. Quality improvement in general practice: An inquiry into the quality of general practice in England. London, UK: The King’s Fund, 2010.
  5. Taylor EF, Machta RM, Meyers DS, Genevro J, Peikes DN. Enhancing the primary care team to provide redesigned care: The roles of practice facilitators and care managers. Ann Fam Med 2013;11(1):80–83.
  6. Institute of Medicine. Crossing the quality chasm: A new health system for the twenty-first century. Washington: National Academies Press, 2001.
  7. Australian Commission on Safety and Quality in Healthcare. Patient-centred care: Improving quality and safety by focusing care on patients and consumers. Discussion paper. Sydney: ACSQHC, 2010.
  8. Mader EM, Fox CH, Epling JW, et al. A practice facilitation and academic detailing intervention can improve cancer screening rates in primary care safety net clinics. J Am Board Fam Med 2016;29(5):533–42.
  9. Michie S. Implementation science: Understanding behaviour change and maintenance. BMC Health Serv Res 2014;14(Suppl 2):9.
  10. 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.
  11. Lembke T, Ewald D, Rahbar S. Patient centred medical home: A quality improvement handbook for general practice [V1.0]. NSW: Australian Government; North Coast Primary Health Network, [date unknown].
  12. Walters SJ, Stern C, Robertson-Malt S. The measurement of collaboration within healthcare settings: A systematic review of measurement properties of instruments. JBI Database System Rev Implement Rep 2016;14(4):138–97.
  13. 1Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: Effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013;(3):CD002213.
  14. Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: A systematic review. BMC Health Serv Res 2013;13:158.
  15. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci 2012;7:50.
  16. Chung VC, Ma PH, Hong LC, Griffiths SM. Organizational determinants of interprofessional collaboration in integrative health care: Systematic review of qualitative studies. PLoS One 2012;7(11):e50022.
  17. Christl B, Lloyd J, Krastev Y, Litt J, Harris M. Preventing vascular disease: Effective strategies for implementing guidelines in general practice. Aust Fam Physician 2011;40(10):825–28.