This clinical audit aims to improve preventive care for vascular conditions for patients who are overweight attending general practice in disadvantaged local government areas in Sydney and Adelaide. It is being conducted as part of the HeLP-GP study which has been approved by the University of NSW Human Research Ethics Committee (HC17474).
All patients aged 40-74 years will be included in the initial non-identified audit of recording of risk factors. After feedback participants will develop plan to improve assessment and recording. Following this 10 patients will be selected who have a BMI of 28 or more and who consent to be part of the study. These identified patients will have levels of risk factors assessed. The GP will review the audit report and plan action both for individual patients and to improve the organisation of care in the practice. This will be repeated again at between 6 and 12 months.
Relevance to General Practice
The "5As" (Assess, Advise, Agree, Assist and Arrange) provides a structured pathway for preventive care in general practice and is part of RACGP guidelines. Progress along the pathway from assessment to follow up is associated with increased patient motivation and behaviour change. However the implementation and effectiveness of preventive care across the 5As in PHC has been poor. in In previous research we have found that, with support, GPs can improve the quality of assessment and recording of behavioural and physiological risk factors . However helping patients to improve lifestyle behaviours (such as diet, physical activity and smoking) and vascular risk factors themselves (such as weight, BP, Lipids) has proven to be much more difficult especially in disadvantaged populations. This appears to be related to low frequency and effectiveness of advice, goal setting, and referral of patients. These are in turn related to organisational, patient and practitioner barriers.
- Participants will improve assessment and recording of behavioural and physiological risk factors for chronic vascular diseases for overweight patients.
- Participants will identify and improvement management of overweight patients with poor control of their behavioural and physiological risk factors
- Participants will establish practice systems to appropriately manage and refer patients with these risk factors to other services*
Domains of General Practice
D1. Communication skills and the patient-doctor relationship
D2. Applied professional knowledge and skills
D3. Population health and the context of general practice
D4. Professional and ethical role
D5. Organisational and legal dimensions
Curriculum Contextual Units
- General practice research
University of Adelaide
South West Sydney Primary Health Network
Central and Eastern Sydney Primary Health Network
Adelaide Primary Health Network