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Putting prevention into practice (Green Book)

Practice nurses

The employment of a practice nurse (PN) may reduce the GP’s workload and provide more rapid access to care for patients. Other areas in which PNs have been shown to be effective includes counselling patients with health problems related to their lifestyle, including smoking, hazardous drinking, nutrition, immunisation, and chronic disease including cardiovascular disease, asthma and diabetes.

Practice nurses may be cost effective as they can be supported through a range of Australian Government incentive programs including the Practice Incentives Program (PIP) Practice Nurse Incentive, 3+ Asthma Program, Diabetes Program, 75+ health assessment, Aboriginal and Torres Strait Islander peoples health assessment, immunisation, wound management, Pap test Medicare rebates, the Nursing in General Practice Training and Support initiative, and training scholarships.

A practice nurse clinic

A PN runs a ‘healthy lifestyle clinic’. Patients are charged $5.00 for this service. The PN uses a questionnaire to elicit patient needs and interests which can lead to further appointments at the practice including the weight loss clinic, the GP, or other providers (such as allied health).

Mary Mathews, Monash Division of General Practice, Victoria

75+ health assessment

The PN can manage the overall process of the 75+ health assessment by:

  • reviewing the practice database to identify people aged 75 years and over eligible for health assessments (during this process the patients who have died, moved or entered residential care may be eliminated)
  • sending invitation letters or contacting patients, or flagging the case notes to prompt the GP to ask the patient about the assessment at the next visit
  • organising appointments to visit the patient’s home to collect comprehensive information required for the assessment. This may include risk of falls, fire alarms, security, food hygiene, medication management and social issues
  • organising an appointment for each patient to see the GP, and informing the GP of the issues identified
  • finalising the assessment after the consult with the GP and organising any further action that is required (eg. referral to other services)
  • updating the recall and reminder system for repeat assessments.

Mary Mathews, Monash Division of General Practice, Victoria

Defining the role of the practice nurse

General practice nursing in Australia identified four different, but overlapping, dimensions of PN responsibilities:

  • clinical care: reflects the nurse’s responsibility to undertake clinical based procedures and activities
  • clinical organisation: reflects the responsibility to undertake activities that require management, coordination and higher level administration of clinical activities, particularly a systems approach
  • practice administration: reflects the responsibility to undertake activities that provide administrative support to the general practice as a business enterprise, and
  • integration that reflects the responsibility to develop effective communication channels within the practice and between the practice and outside organisations and individuals.

The document ‘Nursing in general practice competency standards’ recognises that the role of nurses in general practice varies according to a number of factors including the population profile of the practice, the general practice structure and employment arrangements. The authors suggest that in accordance with education preparation, professional nursing standards, relevant registration and general practice context, nurses could be involved in conducting clinics, health assessments and chronic disease management.

In considering preventive care, the PN role could include:

  • activities focused on individual patients (eg. ‘hazards in the home’ assessments and diabetes management)
  • group activities (eg. asthma or diabetes clinics)
  • linical organisation responsibilities (eg. managing recall and reminder systems and patient registers, patient education materials, patient surveys and the notice board)
  • integration responsibilities in both the practice and the community (including communication, prevention planning and coordination, liaison and advocacy).

The role of the practice nurse in reducing GP workload

Some months into her job, one PN began managing the computerised diabetes and asthma registers, reviewing patient care plans and entering test/follow up reminders in the clinical record. Incidentally, this ensures the practice is eligible for Service Incentive Payments. Patients are impressed by the follow up, and feel ‘cared for’ and ‘supported’ and the GPs feel ‘less pressured’. Along with local GPs, this PN has organised occasional health information and screening sessions covering a range of topics including cerebrovascular disease, diabetes, and men’s health, and is now enrolled for training in order to undertake Pap tests and provide counselling, with a view to further reducing GP workload and work pressures.

Beth Royal, Robinson Street Medical Centre, Camperdown, Victoria