Criterion 1.3.1 Health promotion and preventive care
Our service provides health promotion and illness prevention services that are based on best available evidence.
► A. There is evidence that our service provides multilingual information about health promotion and illness prevention to patients (health records review, document review).
► B. There is a range of multilingual posters, leaflets, and brochures about health issues available or on display in the waiting area or consulting areas (direct observation).
► C. Our medical and other clinical staff can describe how they provide information to patients on issues relating to health promotion and illness prevention, including issues relevant to common patient presentations (interview).
► D. Our health service uses one or more of the following (health records review, document review):
- flagging of patient health records for opportunistic preventive activities
- paper or electronic system showing due dates for preventive activities (subject to informed patient consent)
- paper or electronic reminder system with appropriate informed patient consent.
► E. Our health service participates in national state or territory reminder systems/registers (subject to informed patient consent) (document review).
Health services in prisons need a systematic approach to health promotion, preventive care and early detection and intervention. Health services have the potential to coordinate with other health professionals and key agencies where appropriate, to achieve health promotion and preventive care objectives. This holistic approach to care allows for each patient’s individual circumstances to be considered when providing health promotion, preventive care, early detection and intervention.
Health services are encouraged to provide patients with information about health promotion and illness prevention. Health promotion activities may also be an avenue to help the patient develop confidence in their ability to participate in their own healthcare. Health promotion is distinct from the education and information that medical and other clinical staff use to support their diagnosis and choice of treatment. Such prevention, education and health promotion may be delivered by doctors, nurses or allied health professionals within the health service and reinforced through the use of written materials and resources.
It is useful for patients to self-select information on a range of health issues that may affect or interest them. Providing written material is recommended as patients remember only 3–4 key messages from a consultation. This criterion refers to the many health pamphlets and brochures available from sources such as departments of health, nongovernment organisations, health promotion programs, local community organisations, and support and self help groups. Many of these organisations provide health promotion information at no cost. Some educational materials are also produced in audiovisual format, which may complement the written material in the health service. Health services are encouraged to be selective about the leaflets, brochures and pamphlets they make available as they may vary considerably in quality and reliability.
Prisons should seek to address health challenges that are more prevalent among prisoner populations than the wider community (eg. safe injecting procedures and blood borne virus transmission).
The use of the internet as a source of information about health issues is becoming more common. Health services need to consider the quality of information available on internet sites before using them. Health services are encouraged to use the checklist in the current edition of the RACGP Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting (the ‘green book’)17 (available at www.racgp.org.au/guidelines/greenbook) to help determine whether patient education materials are of suitable quality.
HealthInsite at www.healthinsite.gov.au provides useful information. The Australian Psychological Society has health promotion resources for use by psychologists (www.psychology.org.au) and the Multicultural Mental Health Australia website has health promotion materials in a range of languages (www.mmha.org.au). The Healthy for Life website has specific information for people of Aboriginal and Torres Strait Islander background (www.health.gov.au/healthyforlife).
This criterion also requires health services to have a systematic process for providing preventive care to patients. This may be through the use of formal preventive activities such as patient prevention surveys, or the use of disease registers and recall and reminder systems. It may also be through using patient presentations at the health service as an opportunity to provide health promotion and illness prevention activities in addition to the specific reason for the patient’s visit. Preventive activities need to be based on the best available evidence. Reminder systems need to operate in such a way as to protect the privacy and confidentiality of patient health information. Health services also need to consider their responsibility if they discharge a prisoner or if the prisoner is released from prison or transferred to another prison.
Health services within prisons have a unique opportunity to undertake important health promotion activities. Determinants that contribute to higher morbidity patterns and negative health status in prisons include socioeconomic status, education, social influence and high risk behaviour18,19 and these are all issues that health services in prisons would need to take into account.
Individuals in prisons may have never had the opportunity to access information relevant to improving their health outcomes. Raising awareness of health issues could therefore improve the overall health status of prisoners in the prison. Where patients are able to make informed decisions, the result may have long term positive repercussions, particularly when a patient is released.20
Targeted health promotion activities within the prison (eg. safe injecting education aimed at reducing the incidence of blood borne viruses) can be facilitated by health service staff. Other clinical staff, such as nurses, can be utilised to develop and disseminate information and health promotion activities at no additional cost to the health service.
Some patient health information may also be transferred to national registers (eg. immunisation data) or state and territory based registers (eg. cervical screening or familial cancer registries) in order to improve care. Health services are encouraged to use these registers subject to the patient’s consent. To ensure continuity of preventive care beyond the period of incarceration, discharge planning for a patient should include updating relevant health registers and transferring health information to the health professional who will continue care of the patient, all subject to the patient’s consent.
Health services might also use data collected in clinical software or paper based systems to improve their targeting of prevention activities among patients in prisons (eg. smoking cessation, sexually transmissible infections). Health services may also use information transferred from private pathology providers (eg. diabetes screening, cervical cancer screening) to design and implement preventive activities. This is not only a quality improvement activity (see Criterion 3.1.1: Quality improvement activities) but it also provides a check that the health service is identifying all relevant patients for their health promotion and preventive care activities.
Further information regarding health promotion and preventive activities is available in the current editions of the RACGP Guidelines for preventive activities in general practice (the ‘red book’),21 the RACGP green book,22 and the RACGP Smoking, Nutrition, Alcohol and Physical Activity (SNAP) framework for general practice.23 (All guidelines available at www.racgp.org.au/guidelines.)