Smoking, nutrition, alcohol, physical activity (SNAP)

Quality improvement
☰ Table of contents

Quality improvement activities need to be assigned as the responsibility of at least one staff member. This may be the practice manager or nurse. The practice needs to conduct a SNAP practice plan and consider the use of the plan, do, study, act (PDSA) tool.

In order to assess whether the practice is performing adequately, it is important to assess how frequently:

  • patients’ risk factors are assessed and recorded (coded to allow tracking in software)
  • patients are offered brief interventions
  • patients are referred to various referral services.

It may also be important to determine whether these result in any change in patient behaviour. This can be evaluated by conducting:

  • an audit of medical records
  • a patient survey (it is important to evaluate if your activities are meeting patient needs and expectations).

Auditing computerised records can be difficult depending on the software being used and the extent to which the information is recorded in a structured way. This is relatively easy for patients with diabetes, as most general practice software contains special modules for such patients. Other patient groups may be identified from prescribing records (eg. patients on antihypertensive or lipid-lowering drugs). Many pathology companies can provide you with a list of patients with high cholesterol and triglycerides. Information on SNAP risk factors may be listed in various parts of the computerised record.

Conducting a patient survey, asking patients who have received SNAP interventions to provide feedback on how helpful they found the support provided by the practice, is another potential approach. Conducting audits and surveys has privacy implications. Refer to the Office of the Australian Information Commissioner website for further information. RACGP members can also refer to the Handbook for the management of health information in private medical practice.