Information management and systems
4.5.1 Record and register systems
Information systems can minimise time spent accessing and sorting information. A practice register should be able to generate recall lists of high-risk patients and identify patients overdue for follow-up or reminders. Computerised prompts can also remind the GP of the risk factors that need to be reviewed during the consultation.
Computer-based systems have been demonstrated to improve the quality of preventive care delivered in the primary care setting as recommended by the RACGP’s Quality health records in Australian primary healthcare: A guide (www.racgp.org.au/your-practice/business/tools/support/qualityhealthrecords).
A practice register is a complete and ordered list of patients. It should contain the patient’s:
- date of birth
- phone number
- reason for being on the register
- dates of visits
- smoking and alcohol status.
For SNAP, the register should contain patients known to have CVD (eg. have had a myocardial infarction, unstable angina, stroke, other vascular disease, hypertension, diabetes, or hyperlipidaemia). Local primary health agencies and networks may be able to provide assistance in setting up a practice register and/or involving the practice in a catchment-wide register.
If the patient agrees to be part of your practice recall system, a recall letter should be sent inviting the patient to return to the practice for a consultation, specifying the purpose of the visit (eg. review of smoking cessation), whether the patient will see the nurse as part of that visit and length of the appointment (eg. 30 minutes). The Department of Health has advised that recall is appropriate for follow-up of an existing problem or for preventive care.
Information from some SNAP activities may be uploaded to the Personally Controlled Electronic Health Record (PCEHR). Participating in the PCEHR and/or patient held records can help patients to take a more active role in their own health and monitor their progress. They can also act as vehicles for communication when patients move between different healthcare providers.
4.5.2 Risk assessment tools
Absolute risk assessment tools can provide an estimate of the likelihood of a cardiovascular event. There are several computerised versions of these tools, the best of which allow each of the SNAP risk factors, as well as blood pressure, lipids, family history, and conditions such as diabetes, to be considered. The risk information can be useful in helping to motivate patients to make a lifestyle change and to decide whether certain interventions, such as referral to a dietitian, are warranted.
A number of websites provide absolute cardiovascular risk assessment tools, including:
Other helpful risk assessment tools include the Lung Foundation’s ‘Check in with your Lungs’ (http://lungfoundation.com.au/patient-area/checklist), which is a tool used to highlight smoking, occupational exposure and lung fitness. It can be used as a trigger for further investigation such as spirometery or PiKo-6 to screen for COPD.
A physical activity module that incorporates an assessment of physical activity, provides prompts and produces a physical activity prescription has been incorporated into some general practice software programs.
4.5.3 Patient education materials
Consulting room materials
Patient education materials handed directly to patients by the GP or practice nurse will have significant impact. These should ideally be stored on computers used in the consulting rooms. These materials should be tailored to the patient’s:
- language (and be culturally appropriate)
- health problems (eg. existing CVD)
- readiness to change.
Consider a variety of resources to cater for differing levels of literacy and health literacy among the groups attending your practice. These materials should also be evidence-based and provide a balanced approach to the problem.
State health departments often have multilingual patient education materials available for download or for purchase. Check with your local state or territory health departments for multilingual resources and referral centres available to your area.
The NPS MedicineWise fact sheet Lifestyle Choices for Better Health that addresses preventive health in general practice, (www.nps.org.au/__data/assets/pdf_file/0007/177190/Lifestyle-Choices-Fact- Sheet.pdf) discusses how lifestyle choices directly affect health, as well as how they can help prevent ill health and reduce the number of medications taken. Consumers can also electronically subscribe to the monthly Medicinewise Living publication, which offers up-to-date information on health issues, medicines and medical tests.
NPS MedicineWise offers a Medicines List in hard copy, online and via a smartphone application, providing consumers with a tool to better manage their medicines.
Waiting room materials
The waiting room is an important place for patients to access health information. Material left in the waiting room can act as a prompt for patients to raise issues with the GP or other practice staff. Waiting room materials, including posters, may be available from health promotion units of state health departments, your primary care organisation and non-government organisations such as the Heart Foundation, Diabetes Australia, Cancer Council and other peak bodies.
Leaflets should be clear, simple and unbiased and, if possible, be available in the languages used by patients attending the practice. They need to be replenished periodically (ie. every 3–6 months). Posters are an important way of alerting patients to behavioural risk factors and the fact the GP may be able to help, but they need to be rotated regularly. A poster that is left in the practice for years will become all but invisible. Video materials are also available and can be played in the waiting room.
A practice notice board can provide information about self-help groups and local programs, as well as contact information for patients to self-refer. It is important to keep the notice board up-to-date. Some practices now provide computers in the waiting room that allow patients to access education material from selected websites.
NPS also has a MedicineWise Handbook, which is a hardcover consumer resource that is designed to be read by patients in waiting rooms. It defines health and medical terms and offers a summary of the main message on each page. The MedicineWise Handbook is available at http://webapps.nps.org.au/medicinewisehandbook
A practice newsletter may be a useful way of informing patients about preventive issues. These should regularly contain information about the SNAP risk factors and strategies patients can use to help reduce their risk.
Your practice website can also be used for patient education. All resources created should be made available online. Where possible, this information should be available in patients’ preferred language.
An increasing amount of information and educational materials is available online. Many patients will have previously accessed this information, or will do so after visiting the practice. It is therefore important your practice website features other recommended websites that provide unbiased and evidence-based information.
The Department of Health’s ‘Healthdirect Australia’ website (www.healthdirect.gov.au) is a good example of a useful online resource. Practices may consider placing this and other credible health information website links, such as Immunise Australia, Australian Childhood Immunisation Register and Quit Now, on their own websites.
4.5.4 Referral information
In accordance with the RACGP’s Standards for General Practices (4th edition), patients should be made aware of any potential out-of-pocket expenses charged by other healthcare professionals to support the SNAP activities.
A directory of referral information needs to be readily available in the practice. This should include:
- counselling and self-help groups for smoking cessation (in addition to Quitline)
- dietitian referral information
- drug and alcohol counsellors and self-help groups
- exercise physiologists and physiotherapists
- local programs/councils and services for physical activity (eg. Heart Foundation walking programs)
- a list of telephone health coaching services eg. Health Direct (www.healthdirect.gov.au)
- State- and territory-based health coaching services, including, but not limited to:
Some private health funds also provide free telephone health advice and coaching for their members.
Information should also include more specialised services, such as diabetes and cardiac rehabilitation services.
Many local primary health agencies and networks have SNAP-related programs that have access arrangements to allied health workers such as dietitians, exercise physiotherapists and educators to support practices offering SNAP.