| Project Objectives / Summary:
The project aim was to assist a number of general practices to implement a preventative health framework most relevant to their needs. This was to be achieved through the use of a Primary Care Facilitator (PCF) who would provide academic detailing for interested practices. Specifically, the PCF was to assist GPs and other practice staff become involved in prevention at three levels, namely:
- The structural/organisational level (eg by assisting practices to become health promoting environments by establishing a recall/reminder system);
- The medical level (eg assisting GPs to review their adherence to recognised guidelines); and
- The behavioural level (eg providing training with regard to lifestyle counselling)
The target was to involve GPs in 28 practices in the project. The Division also planned to develop nine detailing modules that would be available to GPs and their practice staff.
Project Outcomes:
To assist practices to develop a prevention framework
A prevention philosophy, for the planning and coordination of a range of implementation strategies, was incorporated to improve the quality and quantity of preventative care provided by GPs, sustained over the long-term. It was anticipated that a prevention plan would improve the management and organisation skills of practices participating in the project.
The module "Prioritising preventative health for your practice" was developed to specifically assist practices to conduct an inventory of current practice and GP prevention activities through administration of an adapted RACGP Practice Prevention Inventory, and a patient needs assessment. This module was undertaken with 10 practices.
The module "Identifying GP & staff resources" was offered and selected by two practices. The modules "Staff and GP training" and "Developing Communication and sustainability" were offered, but not selected.
To assist GPs to review their adherence to nationally recognised guidelines
The primary care facilitator enabled GPs to review their adherence to national guidelines (eg immunisation schedules, pharmacological interventions for risk factors such as high blood pressure, preventions of complications in people with diabetes). This process was strengthened through the employment of a GP detailer to facilitate a reduction in risk factors amongst the practice patients.
The module "Medical detailing of systematic preventative health" to be facilitated by both the primary care facilitator and the GP detailer was offered. It included briefing the practice GPs and staff on the evidence based recommendation that were relevant to their chosen preventative health priorities. This module was not selected by participating practices.
Train GPs in lifestyle counselling and attitude/behaviour change
Through small group activities, GPs were provided with the opportunity to increase their knowledge and skills in recognising appropriate strategies and interventions, which would contribute to the improved health status pf practice patients.
The module "Behaviour modification and lifestyle counselling training" offered training sessions in the area of behaviour modification and lifestyle counselling. This module was not selected by participating practices.
Assist practices to become health-promoting environments
The primary care facilitator provided support to GPs and practice staff to increase awareness of opportunities for practices to take a holistic approach towards new initiatives. This included liaison with reception staff to communicate positive health messages, and utilise the waiting room to promote healthy behaviour. Practices were encouraged and supported to establish a recall/reminder system. The module was not selected by participating practices.
The module "The prevention framework of the whole practice" was offered. It was not selected by any of the participating practices. The module "Activating patient recall/reminder" offered support for the development of a recall/reminder system. The module was not selected by participating practices.
At the date when the project was terminated there had been some successes at the practice level:
- Many practices displaying new health promotion posters and brochures in the waiting room. In many practices there was a system where a practice staff member regularly updated/changed these displays.
- Some practices considered the creation of a strategic Health Promotion Plan that outlined changes planned for the practice and regularly reviews of organisation management systems.
- A number of practices appointed a staff member to coordinate the health promotion activities in the practice. The role has been variable - in some practices it simply involved responsibility for displaying health promotion brochures ad posters, in others included regular communication with staff regarding health promotion.
- A few practices planned to implement reminder systems for health promotion.
List of recommendations:
A culture of preventative health may be fostered in an environment, which ensures there are adequate incentives. It is recommended that practices focus preventative health activities in areas such as the new PIP incentives in the areas of asthma, cervical screening, diabetes and mental health.
Lessons Learnt:
One of our key findings has been that it is easier to introduce change at the practice level, and more difficult to implement change in GP behaviour. Although most GPs agreed that preventative health was an issue to them, there were many barriers that have been difficult to overcome, despite the use of the primary facilitator. These barriers included:
- Lack of time
- Demand on limited human resources in small practices
- An illness orientation in the primary health care setting
- Poor monetary incentives for health promotion activities
The absence of incentives for GPs to become involved in preventative health activities is we believe a critical issue. Most of our GPs are stretched to the limit to provide acute care to their practice population. Why would they take on additional responsibilities in the area of health promotion?
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