Improving Lifestyle Factors

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Improving Lifestyle Factors

• Dr Jane Talbot
• Mead Medical Group

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Mead Medical Group
Two practice sites Kalamunda Forrestfield
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Mead Medical Group

• Medtech32 clinical software
• 8 GP Principals, 5 GP Associates 2 GP
  Registrars (11.4 FTE)
• 1 Practice Manager
• 9 Practice Nurses (3.5 FTE)
• 16 Reception/ Admin staff
• 42,000 patients approx 6,000 per month
• 47 private, 46 HCC/pensioner

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Collaborative Activity

• Wave 2 practice
• gt 800 diabetes patients, gt500 CHD patients
• NPCC gave us the opportunity to focus on core
  business
• Update all factors relating to improving health
  outcomes
• Engaged GPs in overall vision

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Lifestyle factors - involving patients

• Smoking
• Nutrition
• Alcohol
• Physical Activity
• Weight

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The 5 As approach

• ASSIST patient to change
• - medication
• - support
• ARRANGE support
• - Referral
• - Community
• - Follow-up

• ASK about lifestyle
• ASSESS risk level
• ADVISE on healthier choices
• - Brief advice
• - Written information
• - Lifestyle prescriptions
• - Motivational interviewing techniques

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Lifescripts
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Motivational interviewing
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Motivational Interviewing

• is a person-centred, directive method for
  enhancing intrinsic motivation to change by
  exploring and resolving ambivalence
• (Moyers Rollnick 2002)

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Motivational Interviewing

• is a model to describe how people change
• is an effective, innovative method to help people
  with problem behaviours, change their behaviour,
  and can lead to improvement in a client's health
  outcome
• identifies a client's own fears and difficulties
  and helps to resolve the issues

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Putting it into practice

• When booking PAP smear, advised will be double
  appointment for comprehensive Well Womens
  check-up

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Appointment Structure

• Baseline measurements provided by Practice Nurse
  enabled discussion with patient to commence
• Using SNAP concept explored patients readiness
  to change where baseline measurements outside
  normal range
• Utilising Lifescript resource aids prescribed
  interventions which were given to patient when
  she indicated motivation to change
• Baseline blood tests on all patients

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Cont.

• Follow up appointment according to intervention
  arranged
• Arranged information either by website or patient
  handouts
• Referral to Allied Health, support organisations
  considered
• (Consideration for review for GPMP)

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Improvements to Date

• Weight loss
• BP on target
• New diabetics identified
• Smoking cessation

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Considerations

• Lifestyle concepts only work when patient is
  motivated
• No female patient having comprehensive medical
  check has complained
• Patient satisfaction high
• GP satisfaction high
• Financially viable

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Further Considerations

• This method is being introduced opportunistically
  with other disease entities or when unhealthy
  lifestyles are recognised on patient questioning
  eg positive smoking history or excessive alcohol
  consumption
• Case for systematic approach to the utilisation
  of Lifescripts

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Where to from here

• Encourage other GPs to actively DO preventative
  health appts - too busy
• Remember lifescripts SNAP can be part of CDM
  EPC items

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Useful websites

• Australian Government DoHA - Lifescripts
• http//www.health.gov.au/lifescriptskit
• AGPN lifescripts resource library
• http//www.adgp.com.au/site/index.cfm?display5271
  
• Flinders University motivational interviewing
• http//som.flinders.edu.au/FUSA/CCTU/Motivational
  20Interviewing.htm
• RACGP Putting prevention into practice the
  green book
• http//www.racgp.org.au/guidelines/greenbook
• RACGP Guidelines for preventive activities in
  general practice (The Red Book) 6th Edition 2005
• http//www.racgp.org.au/guidelines/redbook
• RACGP SNAP a population health guide to
  behavioural risk factors in general practice
• http//www.racgp.org.au/guidelines/snap

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Questions

• Dr Jane Talbot
• Mead Medical Group
• Email drjmt_at_meadmedical.com.au