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Putting prevention into practice (Green Book)

Iterative cycles

It is important to periodically review implementation interventions to determine whether they are effective in helping patients.147 Improvements frequently come from small adjustments. Regular review provides the opportunity for feedback and reflection.148 Ask the patient about changes that have occurred. Set up review appointments to monitor progress. While this is common with many chronic illnesses it is an underutilised strategy with many lifestyle interventions despite the evidence of the effectiveness of regular review. Review progress at practice management and team meetings. While the GP's relationship with the patient continues over time, prevention strategies may change. Similarly, most behaviour change involves a cyclical process with many patients relapsing after attempting to make changes. Remember:

  • patients may change their mind about the acceptability of a prevention activity after refusing initially
  • the patient's status may change over time (eg. recent ex-smokers may relapse to smoking again)
  • patient motivation also fluctuates with time and may require boosters and additional discussion to clarify their interest in changing.