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Putting prevention into practice (Green Book)

A framework for prevention in general practice

Key messages

  • Current prevention performance can be improved. Effective implementation of prevention requires three main components 47:
    • an appropriate framework
    • clear and well defined processes
    • use of evidence based strategies
  • The core elements of a prevention framework are principles, receptivity, ability, coordination, targeting, iterative cycles, collaboration, effectiveness and efficiency (PRACTICE)

Consider, that for a typical 100 patients seen by a GP:

  • 10–15 patients would not have had their blood pressure measured in the past 2 years
  • 20–30 adults would not have had their lipids tested in the past 5 years
  • out of 60 women patients, 12–15 would not have had a Pap test in the past 2 years
  • 60–70 patients would not have ever been asked about alcohol consumption
  • 20 patients would not have been asked about smoking, and only 10 would have ever had advice from a GP to quit
  • 30–50 people with a tetanus prone wound would not have had a tetanus booster
  • five out of 15 patients aged 65 years and over would not have had an influenza vaccination this year, and 16 out of 25 would not have had the pneumococcal vaccine in the past 5 years
  • 3–6 of every 20 women aged 50–65 years of age would not have had a mammogram in the past 2 years. 48,49

And more generally:

  • Current prevention performance falls below a desirable standard
  • There is a long lag time between the availability of new knowledge and its implementation into routine clinical care
  • While there is good evidence that a number of implementation strategies improve the delivery of clinical care and health outcomes, practices need to carefully target which strategies they use
  • Health outcomes can be improved by paying closer attention to implementation issues.50

Levels of prevention activities in general practice which are either below a desirable level and/or below national targets include:

  • enquiries about alcohol consumption and smoking
  • counselling about hazardous drinking, smoking, inactivity and diet
  • immunisation in adults (especially pneumococcal vaccination and patients at risk)
  • cancer screening (mammography, Pap tests, colorectal cancer screening)
  • assessment of other cardiovascular risk factors (including blood pressure and lipids)
  • achievement of desirable endpoints for a number of chronic diseases.

A systematic approach that focuses on the relevant population is associated with improved prevention and health outcomes.