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Clinical guidelines

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people Second edition

What’s new in the second edition?

The format of the second edition of the National Guide has been significantly revised to give some structure to the different types of preventive activities delivered by primary healthcare providers. All the evidence underpinning the recommendations is included in the preamble to the recommendations.

The format of the National Guide is now also better aligned with the RACGP red book. The guide aims to complement the red book by dealing with health issues that are specific to the Aboriginal and Torres Strait Islander population. Where issues common in the general Australian population have not been dealt with in this National Guide (eg. urinary incontinence), health professionals are encouraged to cross reference with the red book.

New chapters
Gambling Recommends interventions to prevent gambling related harms: the identification and management of problem gambling and gambling prevention strategies including community activities
The health of young people Focuses on three key preventive health issues for young people: psychosocial assessment, unplanned pregnancy and illicit drug use
Rheumatic heart disease Provides recommendations for all people in addition to those with a history of acute rheumatic fever/rheumatic heart disease and communities where Group A streptococcal infections are common and acute rheumatic fever is prevalent
Antenatal care Focuses on five key preventive health issues for pregnant women: general assessment at the first antenatal visit, smoking cessation, alcohol consumption, genitourinary and bloodborne virus infections and nutritional assessment and supplementation
Mental health Focuses on screening for depression and suicide prevention
Preventive health for the elderly Focuses on three key preventive health issues for elderly people: osteoporosis, falls and dementia
Key changes to existing chapters
TopicKey changes
Smoking New recommendations include assessing smoking status regularly, assessing level of nicotine dependence and implementing a system to identify all smokers and document tobacco use
Overweight/obesity New behavioural recommendations for overweight/obese people including assessing the risk/benefit of orlistat and bariatric surgery, and the need to advocate for community based interventions to increase access to healthy food
Physical activity New behavioural recommendations for people that are insufficiently active, have diabetes and/or cardiovascular disease. Levels of physical activity align with the Australian National Physical Activity Guidelines 2010
Alcohol New recommendations include screening for hazardous drinking in high risk groups, considering screening for people 10–14 years and advising women to limit their alcohol intake to no more than 2 standard drinks/day if they choose to drink while breastfeeding. Health professionals to promote community-led strategies to reduce alcohol supply
Child health Includes a significant number of key changes under immunisation, anaemia, growth failure and childhood kidney disease
Dental health New recommendations include non-dental professionals undertaking oral health reviews in addition to regular dental health professional reviews, application of fluoride varnish for 0–5 year olds, and antibiotic prophylaxis prior to dental procedures for people at high risk of endocarditis. Health professionals to advocate for fluoridation of the community water supply
Eye health New recommendations for eye examinations and visual acuity assessments throughout the lifecycle as well as specialised assessments for people with cataracts or diabetes. Advice for smokers and reducing ocular exposure to UV-B light to reduce cataracts
New trachoma and trichiasis recommendations for those in trachoma endemic areas include community screening programs, eye examinations for adults >40 years and prevention and control strategies. Assessing housing situations for overcrowding and providing support is also relevant for people outside of trachoma endemic areas
Hearing loss New recommendations include various vaccinations for children aged <15 years and pregnant women, providing hearing screening throughout the lifecycle, and new behavioural, chemoprophylaxis and environmental recommendations
Sexual health and bloodborne viruses Adds general prevention advice that includes behavioural and environmental recommendations and screening for chlamydia, gonorrhoea, trichomonas vaginalis, syphilis and hepatitis B. Updated immunisation advice has been included for hepatitis B, human papilloma virus, hepatitis A, hepatitis C and human immunodeficiency virus
Respiratory health This chapter focuses on five key preventive respiratory health issues: pneumococcal disease, influenza, asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and suppurative lung disease. Asthma, bronchiectasis and suppurative lung disease are new topics
New recommendations for influenza prevention, encouraging good hygiene practice and minimising exposure risk for healthcare workers. Other changes include consideration of chemoprophylaxis for people at high risk of influenza complications and community based strategies to improve vaccination uptake
New recommendations for pneumococcal disease prevention include promotion of strategies to improve pneumococcal vaccination uptake such as reminder/recall systems and community awareness
New recommendations for COPD include offering vaccination, screening for symptoms of COPD, discussing smoking cessation and minimising other risk factors for COPD and pharmacotherapy to improve quality of life
Cardiovascular disease This chapter focuses on recommendations to determine the absolute risk for cardiovascular disease (CVD) based on multiple risk factor assessment for people without an established diagnosis of cardiovascular disease. Framingham, non-Framingham risk factors and clinically high risk conditions are presented as well as recommendations for chemoprophylaxis. Recommendations for those with an established diagnosis of CVD are also presented. The Australian cardiovascular risk charts are given in Appendix 1
Chronic kidney disease New recommendations include screening for chronic kidney disease (CKD) risk factors for those without risk, screening for CKD with eGFR and urinary albumin-creatinine ratio for those with a risk factor, and supporting population-based strategies to reduce scabies and pyoderma among children. Numerous behavioural and chemoprophylaxis recommendations have also been included
Diabetes prevention New recommendations include screening for diabetes from >18 years of age in regions with high diabetes prevalence and/or with high risk conditions, but consider an AUSDRISK assessment only in populations with low prevalence. Behavioural recommendations focus on diet, physical activity and breastfeeding. Pharmacotherapy is discussed for people with a high risk condition and advocacy for community based interventions are recommended
Cancer Focuses on five areas for prevention and early detection of cancer: cervical, breast, liver, prostate and bowel cancer. Liver, prostate and bowel cancer are new topics
New recommendations for cervical cancer include promoting human papilloma virus (HPV) vaccination and commencing Pap screening regardless of HPV vaccination status. Other recommendations include assessing smoking status and offering a sexual health review
New recommendations for breast cancer include discussing familial breast cancer and breast awareness, while mammographic screening differs depending on age and level of risk. New behavioural recommendations cover physical activity, diet, alcohol consumption, smoking and breastfeeding. Hormone replacement therapy and other pharmacotherapy are discussed
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