Putting prevention into practice Guidelines for the implementation of prevention. in the general practice setting Third edition,Disclaimer. The information set out in this publication is current at the date of first publication and is intended for use as. a guide of a general nature only and may or may not be relevant to particular patients or circumstances Nor. is this publication exhaustive of the subject matter Persons implementing any recommendations contained. in this publication must exercise their own independent skill or judgement or seek appropriate professional. advice relevant to their own particular circumstances when so doing Compliance with any recommendations. cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with. the health professional and the premises from which the health professional operates. Accordingly The Royal Australian College of General Practitioners Ltd RACGP and its employees and. agents shall have no liability including without limitation liability by reason of negligence to any users of the. information contained in this publication for any loss or damage consequential or otherwise cost or expense. incurred or arising by reason of any person using or relying on the information contained in this publication. and whether caused by reason of any error negligent act omission or misrepresentation in the information. Recommended citation, The Royal Australian College of General Practitioners Putting prevention into practice Guidelines for the. implementation of prevention in the general practice setting 3rd edn East Melbourne Vic RACGP 2018. The Royal Australian College of General Practitioners Ltd. 100 Wellington Parade,East Melbourne Victoria 3002. Tel 03 8699 0414,Fax 03 8699 0400,www racgp org au. ABN 34 000 223 807,ISBN 978 0 86906 493 1 Print,ISBN 978 0 86906 494 8 Web. Published May 2018, The Royal Australian College of General Practitioners 2018. This resource is provided under licence by the RACGP Full terms are available at www racgp org au. usage licence In summary you must not edit or adapt it or use it for any commercial purposes You must. acknowledge the RACGP as the owner, We acknowledge the Traditional Custodians of the lands and seas on which we work and live and pay our. respects to Elders past present and future,of improving. preventive health,activities,Putting prevention into practice. Guidelines for the implementation of prevention,in the general practice setting. Third edition,Putting prevention into practice, Guidelines for the implementation of prevention in the general practice setting Third edition. Acknowledgements, The Royal Australian College of General Practitioners RACGP gratefully acknowledges the generous contribution. of the following authors contributors and reviewers of Putting prevention into practice Guidelines for the. implementation of prevention in the general practice setting Green Book third edition. Green Book Editorial Committee, Professor Danielle Mazza Associate Professor Charlotte Hespe. Chair Green Book Editorial Committee Head Department Head General Practice and Primary Care Research. of General Practice Monash University Conjoint Professor School of Medicine University of Notre Dame General. School of Medicine and Public Health University of Practitioner Glebe Family Medical Practice NSW Vice. Newcastle NSW Fellow Society of Family Planning USA President RACGP Chair RACGP NSW ACT. RACGP Expert Committee Quality Care,Dr Cory Lei, Ms Karen Booth General practice registrar Currambine Family Practice WA. President Australian Primary Health Care Nurses,Associate Professor John Litt. Association,Deputy Chair RACGP Expert Committee Quality Care. Ms Jan Chaffey,Ms Genevieve Nolan,Chief Executive Officer Camp Hill Healthcare Qld. Programs Manager MOVE muscle bone joint health, RACGP Expert Committee eHealth and Practice Systems. Scientia Professor Mark Harris,Dr Raquel Newman,Centre for Primary Health Care and Equity UNSW. Medical Writer and Information Designer Serum,Sydney Centre for Obesity Management and. Communications Vic, Prevention Research Excellence in Primary Health Care. COMPaRE PHC NSW RACGP Expert Committee,Quality Care. Contributors,Dr Christine Boyce Dr Robert Hosking, General Practitioner Hobart Tas General Practitioner The Elms Family Medical. Centre Vic RACGP Expert Committee eHealth and,Ms Alice Creelman. Practice Systems, Cancer and Palliative Care Branch Population Health. and Sport Division Department of Health Ms Sally Jarrett. Practice Manager Stirling Central Health Clinic SA. Professor Christopher Del Mar, Faculty of Health Science and Medicine Bond Dr Caroline Johnson. University Qld Senior Lecturer Melbourne Medical School Vic. RACGP Expert Committee Quality Care,Dr Michael Fasher. General Practitioner and Adjunct Associate Professor Dr Andrew Knight. University of Sydney Fairfield GP Unit NSW,Ms Anne Fritz Mr Alessandro Luongo. Practice Manager Kingston Family Practice Clinical QI Coordinator South Western Sydney. Brighton SA Primary Health Network NSW,Ms Kylie Gibson Ms Fiona Thompson. Practice Manager Fisher and Holder Family Clinical Services Manager Pangula Mannamurna. Practice ACT Aboriginal Corporation SA,Dr Elizabeth Hindmarsh Ms Lauren Trask. Co author of the RACGP s Abuse and violence Working Accreditation Specialist Queensland Aboriginal and. with our patients in general practice White Book Islander Health Council. Putting prevention into practice, ii Guidelines for the implementation of prevention in the general practice setting Third edition. Conflicts of interest, This publication has been produced in accordance with the rules and processes outlined in the RACGP Conflict of. Interest COI Policy The RACGP COI Policy is available at www racgp org au support policies organisational. We gratefully acknowledge the expert reviewers and representatives from the organisations who contributed. scholarly feedback,Chris Ash Ms Beverley Korn, Senior Project Officer Gold Coas t Primary Health Primary Health Care Gold Coast Primary Health. Network Qld Network Qld,Dr Donita Baird Dr Robbie Lloyd. Clinical Psychologist Vic Port Macquarie Community College NSW. Dr Melanie Dorrington Professor Finlay Macrae, Bungendore Medical Centre NSW Head Colorectal Medicine and Genetics Royal. Melbourne Hospital Professor Department of Medicine. Dr Daniel Ewald,University of Melbourne Royal Melbourne Hospital. Lennox Head Medical Centre NSW,Dr Scott McKeown,Ms Felicia Fletcher. General Practitioner and Public Health Physician, Integrated Team Care Project Officer Capital Health. Aboriginal Health Service Tas,Network ACT,Associate Professor Mark Morgan. Dr Oliver Frank,Associate Professor Faculty of Health Sciences. Oakden Medical Centre SA RACGP Expert,and Medicine Bond University RACGP Expert. Committee eHealth and Practice Systems,Committee Quality Care. Dr Brendan Goodger,Dr Jeremy Nunis,Population Health and Chronic Disease Manager. Owen Terrace Medical Practice SA,Central and Eastern Sydney PHN NSW. Dr Rosalie Schultz,Professor Moyez Jiwa,Ngaanyatjarra Health Service NT. Wyndham Health Centre Vic RACGP Expert, Committee Standards for General Practices Dr Sunita Thavarajadeva. Mawson Lakes Healthcare SA,Putting prevention into practice. Guidelines for the implementation of prevention in the general practice setting Third edition. Acronyms and abbreviations, 5As ask assess advise agree assist arrange PRACTICE Principles Receptivity Ability and capacity. Coordination Targeted Iterative cycles, APNA Australian Primary Health Care Collaboration Effectiveness and efficiency. Nurses Association,QI quality improvement,AUSDRISK Australian Type 2 Diabetes Risk. Assessment Tool QI CPD Quality Improvement and Continuing. Professional Development Program,BMI body mass index. RACGP The Royal Australian College of, CALD culturally and linguistically diverse General Practitioners. CCF congestive cardiac failure RE AIM reach effectiveness adoption. CIS clinical information system implementation maintenance. CISS Computer and information security standards SIP Service Incentive Payment. CME clinical medical education SMART Specific Measurable Assignable Realistic. Time related, COM B capability opportunity motivation and behaviour. SNAP smoking nutrition alcohol physical activity,COPD chronic obstructive pulmonary disease. TPB theory of planned behaviour,CPD continuing professional development. CVC Coordinated Veterans Care,CVD cardiovascular disease. DASS Depression Anxiety and Stress Scale,DMAIC define measure analyse improve control. ED emergency department,EPC extended primary care,FAV family abuse and violence. FOBT faecal occult blood test,GASP GPs Assisting Smokers Program. GP general practitioner,HANDI Handbook of non drug interventions. HbA1c glycated haemoglobin,HHS hyperosmotic hyperglycaemic syndrome. IT information technology,KTA knowledge to action,MBS Medicare Benefits Schedule. MI motivational interviewing,NBCSP National Bowel Cancer Screening Program. NHS National Health Service,NPT normalisation process theory. PDSA plan do study act,PHN Primary Health Network,PLAN Planning learning and need. PN practice nurse,PPIP Putting Prevention into Practice program. Putting prevention into practice, Guidelines for the implementation of prevention in the general practice setting Third edition. 1 Contents,Acknowledgements i,Green Book Editorial Committee i. Contributors i,Conflicts of interest ii,Reviewers ii. Acronyms and abbreviations iii,Introduction 1,The Green Book 1. 1 Understanding the basics 5,1 1 About prevention 5. 1 2 About implementation 9, 1 3 Bringing prevention and implementation together 11. 2 Whole of practice prevention 15,2 1 Your practice population 15. 2 2 Your practice team 18,2 3 Team collaboration 20. 3 Approaches to implementation 23, 3 1 Using an implementation framework to help you put prevention into practice 23. 3 2 An overview of the PRACTICE framework 25,4 Putting prevention into practice 30. 4 1 Principles 30,4 2 Receptivity and engagement 32. 4 3 Ability and capacity 34,4 4 Coordination of people and processes 35. 4 5 Targeted to people and priorities 36,4 6 Iterative cycles 38. 4 7 Collaborating to make it work 40,4 8 Effectiveness and efficiency 41. 5 Setting up the practice for preventive care 57, 5 1 Managing patient information to support preventive care 57. 5 2 Creating an environment that supports prevention 60. Appendix A Frameworks to change patient behaviour 67. A 1 The 5As 67,A 2 Motivational interviewing 67,Appendix B The COM B model 70. The COM B model 70,Appendix C Implementation frameworks 72. C 1 The plan do study act cycle 72,C 2 Knowledge to action framework 73. C 3 The DMAIC model 75,Putting prevention into practice. vi Guidelines for the implementation of prevention in the general practice setting Third edition. Appendix D Case studies and stories presented in the Green Book 77. D1 Primary Health Network helping new owners of a practice 77. D2 Providing care to practice communities 77, D3 Working together to improve the health of Aboriginal and Torres Strait Islander peoples 78. D4 Using the Red Book with patients 78,D5 Risk factors in local practice population 78. D6 Improving immunisation rates 79,D7 Preventing childhood obesity 79. D8 Providing comprehensive care to Aboriginal and Torres Strait Islander peoples with chronic comorbities 80. D9 Improving practice data for better health outcomes 81. D10 Improving weight by working together 81,D11 Wellness and weight groups in practice 82. D12 Change talk 82, D13 Use of facilitator to improve delivery of screening and prevention 83. D14 Improving care of patients with coronary artery disease 83. D15 GPs Assisting Smokers Program 84, D16 Collaborating to help patients with complex issues 84. D17 Targeting patient groups to improve bowel screening 86. D18 Using data to improve bowel screening 87,D19 Using data to improve your practice 88. D20 Using demographic data to improve care 88,D21 Modelling behaviour 88. Figure 1 How the Green Book fits with other RACGP publications 2. Figure 2 The determinants of health and illness 6, Figure 3 Primary secondary tertiary and quaternary prevention 7. Figure 4 Barriers and enablers of implementation 9. Figure 5 Levels where interventions may be delivered 10. Figure 6 The QI team 19,Figure 7 Gantt chart in practice 39. Figure 8 Reality pyramid for smoking cessation 45,Figure B1 The COM B model 70. Figure C1 PDSA cycle 72,Figure C2 The KTA process Example 74. Figure C3 The DMAIC model 75,Table 1 Implementation theories and frameworks 23. Table 2 PRACTICE components 25, Table 3 Improving general practice engagement in preventive care delivery 33. Table 4 Effectiveness of implementation strategies 42. Table A1 The 5As 67,Box 1 Guidelines 41,Box 2 Making the process more strategic 41. Box 3 Reminders recalls and prompts 60, Box 4 Tips for setting up a high quality website 60. Putting prevention into practice, Guidelines for the implementation of prevention in the general practice setting Third edition. Introduction, Focusing on prevention is an important response to Australia s increasing healthcare needs. In general practice we are well trained and skilled in caring for and working alongside patients who present with multiple. issues and health related problems What we don t do often is step back from the individual before us and consider our. patients as a community or population Yet this shift in focus holds enormous potential to improve health outcomes While. we continue supporting individuals to take greater responsibility for their health and prevent illness if we also work at a. practice population level we have opportunities to affect the broader determinants of health and illness. Improving preventive care for individuals and communities leads to better health 1 To this end multiple evidence. based recommendations have been developed The Guidelines for preventive activities in general practice ninth. edition Red Book is a key source of these However when we look across general practice implementation and. delivery of preventive services is variable 2 3, It is not our medical knowledge that can adversely affect our ability to deliver preventive care Rather it is our. ability to recognise and overcome a combination of individual factors eg time pressures competing demands. skill levels attitudes and practice systems and organisational factors eg availability of a team clarity of roles. lack of resources a culture focusing on treatment rather than prevention Putting preventive recommendations. into practice requires knowledge in areas we are not well taught such as implementation science change. management organisational behaviour and data collection and analysis. In Putting prevention into practice Guidelines for the implementation of prevention in the general practice setting. Green Book we aim to give you enough useful knowledge in the above areas to create a clear and actionable. plan to improve your practice s preventive care,The Green Book. Since 1998 The Royal Australian College of General Practitioners RACGP has published the Green Book to. support evidence based preventive activities in primary care. What is the Green Book, The Green Book is designed to help you put preventive care recommendations from best practice guidelines into. practice It provides case studies to reflect on and contains advice about practical processes strategies and tools. for implementing and sustaining preventive activities. The Green Book brings together the evidence and the lessons learned from the literature and from real life general. practice experiences to make implementation of preventive activities as straightforward and effective as possible. These lessons include, Simply disseminating guidelines within your practice is not enough to change practice. Using a practical framework that is guided by theory can improve success. Implementing all recommendations from evidence based guidelines may be unrealistic and unachievable what. you chose to implement depends on your practice context ie established need clinician preference complexity. capacity capability and resources available, Improving implementation depends on changing multiple behaviours of multiple people ie healthcare. professions practice managers administrators, Implementation efforts are more likely to be successful if you have strong organisational leadership and whole. of practice engagement,You need to set goals that you can measure. By aligning leadership building capacity for change creating a culture of quality improvement QI and selectively. choosing the relevant processes needing change general practices can organise their environment to successfully. deliver preventive services 4,Putting prevention into practice. 2 Guidelines for the implementation of prevention in the general practice setting Third edition. How does the Green Book fit in with other RACGP publications. You can think of the Green Book as a practical companion to the RACGP s Red Book However it also works to. support the implementation of other RACGP publications such as Smoking nutrition alcohol physical activity SNAP. A population health guide to behavioural risk factors in general practice second edition and the National guide to a. preventive health assessment for Aboriginal and Torres Strait Islander people third edition National Guide Figure 1. The Green Book is also a resource to help your practice meet the RACGP Standards for general practices fifth edition. the Standards, Figure 1 How the Green Book fits with other RACGP publications. Evidence based How to put Demonstrate and,recommendations recommendations reflect on high. into practice quality patient,care and practice,Book Green Standards. SNAP Planning Clinical,guide learning indicators,National Home. Guide gplearning,White Information,Book security,in general. Supporting,smoking QI CPD,cessation Program,Other eHealth. and digital,business kits,Putting prevention into practice. Guidelines for the implementation of prevention in the general practice setting Third edition. Who is the Green Book for, The Green Book is a practical resource for strengthening preventive activities in general practice As an. interdisciplinary approach to prevention is typically more likely to be successful 5 the Green Book is a central. resource for your whole practice and for those working with your practice including. members of the practice team involved in or interested in QI. members of practice teams responsible for implementing evidence based guidelines. practice management decision makers, groups working with general practices to improve Australian healthcare such as Primary Health Networks. PHNs particularly QI support officers, peak bodies eg Consumers Health Forum Diabetes Australia Cancer Australia Heart Foundation. allied health professionals,It may also be useful for patients and carers. Organisation of the Green Book, Throughout the Green Book you will find symbols that signal the type of information presented. Where you see this symbol The information relates to. General practice a whole of practice approach,External organisations PHNs peak bodies. A practice management point,A clinical point,An idea you could use in general practice. A case study from one of our contributors,An experience from general practice. Putting prevention into practice, 4 Guidelines for the implementation of prevention in the general practice setting Third edition. Cancer Australia https canceraustralia gov au, Consumers Health Forum of Australia https chf org au. Department of Health Primary Health Networks www health gov au PHN. Diabetes Australia www diabetesaustralia com au,Heart Foundation www heartfoundation org au. Practice guides and tools Clinical indicators Clinical indicators for Australian general practice www racgp org. au clinicalindicators,gplearning http gplearning racgp org au. Guidelines for preventive activities in general practice Red Book ninth edition www racgp org au your. practice guidelines redbook, Information security in general practice www racgp org au your practice ehealth protecting information. information security, National guide to preventive health assessment for Aboriginal and Torres Strait Islander people National Guide. third edition www racgp org au your practice guidelines national guide. Planning learning and need PLAN www racgp org au education qicpd program gps planning learning and. QI CPD Program 2017 19 triennium handbook for general practitioners www racgp org au download. Documents QICPD 2017 QICPD Handbook triennium 2017 19 pdf. Smoking nutrition alcohol physical activity SNAP A population health guide to behavioural risk factors in. general practice second edition www racgp org au your practice guidelines snap. Standards for general practices fifth edition www racgp org au your practice standards standards for general. practices 5th edition, Standards for patient centred medical homes Patient centred comprehensive coordinated accessible and. quality care www racgp org au download Documents Standards RACGP Standards for Patient Centred. Medical Homes pdf,References, 1 The Royal Australian College of General Practitioners Guidelines for preventive activities in general practice 9th edn East. Melbourne Vic RACGP 2016, 2 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing health promotion. activities in general practice An explorative pilot study BMC Fam Pract 2013 14 20. 3 Grunfeld E Manca D Moineddin R et al Improving chronic disease prevention and screening in primary care Results of the. BETTER pragmatic cluster randomized controlled trial BMC Fam Pract 2013 14 175. 4 Knierim KE Fernald DH Staton EW Nease DE Jr Organizing your practice for screening and secondary prevention among. adults Prim Care 2014 41 2 163 83, 5 Registered Nurses Association of Ontario Toolkit Implementation of best practice guidelines 2nd edn Toronto RNAO 2012. Putting prevention into practice, Guidelines for the implementation of prevention in the general practice setting Third edition. 1 Understanding the basics,Key points, Prevention is relevant to patients across all life stages and applies to the whole natural history of disease. Implementing preventive activities involves recognising the challenges of implementation and using. evidence based strategies to overcome them, Successful implementation of preventive care requires coordination and collaboration within the practice. team and with external organisations eg PHNs,Focusing on prevention is part of a QI approach. The Green Book brings together two main themes prevention and implementation Both of these sit within QI. and are inherently associated with behaviour change. 1 1 About prevention,What is prevention, While many general practitioners GPs and practice nurses PNs discuss lifestyle with their patients this is only. the tip of preventive care 1 Prevention in the healthcare context focuses on the health of individuals communities. and defined populations It includes all measures that protect promote and maintain health and wellbeing and that. prevent disease disability and death 2 4, Prevention in practice requires us to extend our patient centred approach from individuals and families to the entire. practice population, I ve always been taught to do acute episodic care in response to patient demand But I have realised that to really. look after my patients I have to do chronic disease management and prevention and that I need to do it in a. proactive and planned way, Assoc Prof Charlotte Hespe Green Book Editorial Committee. Prevention people and practice population, Prevention is relevant across a person s lifespan from pre conception fetal stage childhood and adolescence. through to middle age and older The Red Book shows the preventive activities that apply across age groups. There are many determinants of health and illness Figure 2 A preventive approach recognises these and how they. interact It also reaches beyond individuals who seek out or are most receptive to preventive care to encompass.
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In this section, briefly describe changes in policies or programs discussed in last year s PHA Plan that are not covered in other sections of this Update. The Polk County Board of County Commissioners was designated in 1990 as the PHA for Polk County, Florida. The Section 8 Program is administered by the Human Services Department,
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