The role of primary health care in preventing the onset of chronic disease, with a particular focus on the lifestyle risk factors of obesity, tobacco and alcohol. Mark Harris Centre for Primary Health Care and Equity, UNSW January 2008 Abstract The potential impact of primary health care in assessing and managing smoking, hazardous drinking, poor diet and physical inactivity has been demonstrated among patients who are at higher risk. Effective interventions based around the 5As approach include the assessment of risk and readiness to change, brief motivational interventions and referral of suitable patients for more intensive interventions. Health checks have been demonstrated to improve the frequency of preventive care and support for behaviour change. However their impact on health outcomes is uncertain. Expansion of the current complexity of different Medicare items is undesirable. Health checks should focus on specific evidence based preventive actions and involve the use standardized resources such as Lifescripts and integrated health risk assessment tools. Other performance based incentives may be useful in targeting the needs of specific groups and encouraging primary health care to provide more outreach and culturally appropriate preventive care for disadvantaged groups. General practice referral of patients needing more intensive lifestyle interventions is infrequent due to a number of factors including cost and availability of providers and services and the integration between these services and primary health care. A major role of primary health care organisations is to coordinate and broker a network of referral services to support behaviour change based on standards and quality assurance. Other key roles of primary care include the support of practices to monitor and improve their performance in providing preventive care. Structural reform of primary health care may provide opportunities for more integrated approaches to management of the lifestyle risk factors across private and public and national and state funded services.
Commissioned Paper for National Preventative Health Taskforce 14/01/09
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The role of primary health care in preventing chronic disease
1. Rationale for a role for primary health care in prevention of chronic disease Chronic vascular diseases including heart disease, diabetes, kidney disease and stroke represents a substantial and increasing portion of health care expenditure and practitioner workloads 1 2 . Behavioural risk factors for these include smoking, poor nutrition, hazardous alcohol consumption and physical inactivity (known by the acronym SNAP). In 2001, 53% of the Australian adult population had two or three and 16% had four or more of the following vascular risk factors: tobacco smoker, physical inactivity, high blood pressure, high blood cholesterol, obesity, low fruit or vegetable consumption, risky alcohol consumption or diabetes 3 . Recognition of the escalating costs and burden of chronic disease has led to an increasing research to identify effective approaches to prevention. There is now considerable evidence for the effectiveness of interventions to prevent vascular disease in high risk populations 4 . Large studies in China, Finland and USA have also demonstrated the feasibility of preventing, or delaying, the onset of diabetes in high risk patients 5 6 7 . Prevention of chronic disease is an important priority for the Australian health system. Early in 2006, the Council of Australian Governments in its “Plan for Better Health for All Australians” 8 identified the importance of promoting healthy lifestyles, including addressing alcohol use, nutrition, smoking and physical activity. It proposed that this be achieved through:• supporting the early detection of lifestyle risks and chronic disease through a “Well Person’s Health Check” in general practice for middle aged people with...