Doctors Central To Preventative Health Strategy - Australian Medical Association

Main Category: Preventive Medicine
Article Date: 06 Jan 2009 - 2:00 PDT

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Recognising and supporting the role of doctors in preventative health care are crucial in developing a preventative health strategy to tackle chronic disease in Australia, the AMA has said.

The AMA recently presented its submission to the National Preventative Health Taskforce that was established earlier this year by the Minister for Health and Ageing, Nicola Roxon, to develop a National Preventative Health Strategy for Australia.

AMA President, Dr Rosanna Capolingua, said the AMA welcomed the opportunity to respond to the options for prevention of obesity, smoking and alcohol abuse that are explored in the Taskforce's discussion paper, Australia: The Healthiest Country by 2020.

Dr Capolingua said she was pleased that the Taskforce had endorsed many of the public health prevention measures the AMA had been advocating for some time.

"Doctors are integral to prevention in the health system," she said.

"Each and every encounter with a patient is an opportunity to protect patients from illness and help to prevent them from becoming sick. The Taskforce must recognise that this role needs to be appropriately supported.

"The idea of preventative care is nothing new for doctors - GPs in particular practise preventative care every time they see a patient.

"GPs are always on the look out for health risks and early-warning signs of disease. These cover nutrition and obesity, sun exposure, smoking, alcohol, physical activity, family history, environmental exposures, mental health issues and a myriad of factors that can impact on health and wellbeing in both the short and long term.

"Doctors are in a unique position to discuss preventative health with their patients and actively influence them to make healthy changes to their lives."

Approximately 88% of all Australians visit a GP at least once a year, and studies consistently show that doctors' advice commands a high level of credibility and respect from their patients.

Dr Capolingua said doctors had significant opportunities to address the health risks of a very large proportion of the Australian population, and to help people manage their own health better.

"If we are to seriously tackle the growing burden of chronic disease in this country then we need to make sure that the work of doctors, in preventing harm from obesity, smoking and alcohol use, is fully supported."

The AMA recommends to the Taskforce that doctors should be supported by:

-- appropriately recognising the time doctors devote to preventative care with patients,

-- enabling practice nurses to sometimes provide prevention advice to a patient for and on behalf of the doctor,

-- supporting specific staff roles to coordinate preventative care for patients in a medical practice,

-- distributing to doctors practical information about the latest best-practice techniques for addressing smoking, alcohol and weight problems, and

-- supporting medical practices in providing group educational and preventative health sessions for patients.

Dr Capolingua said it was also important that doctors' expertise and practical experience were fully utilised in developing the public health prevention campaigns and initiatives in a national preventative health strategy.

The full AMA submission to the Taskforce can be viewed online at www.ama.com.au/node/4402

Prevention In Medical Practice: Supporting the Role of the Doctor

Recommendation 1

Any strategic consideration of the place of prevention in the primary care setting must begin with recognition of the following facts:

-- Doctors have a central place in the primary care setting;

-- Doctors already routinely integrate prevention into their patient consultations, and doctors are integral to prevention in the health system, particularly secondary prevention.

Recommendation 2

The uptake and integration of brief interventions into routine medical practice across Australia should be increased through:

Dissemination of best-practice information to doctors about
-- the most effective forms of brief intervention in a routine clinical setting for each risk factor; and
-- what is effective for different population groups, including prevention 'target groups' such as adolescents and youth.
-- Significantly increasing the research and evaluation effort to identify brief or other interventions that doctors can apply with good effect in the case of overweight and obesity;

Involving the AMA, in providing practice-based quality assurance on:
-- the development of prevention guidelines and protocols, to ensure their practicality in a practice context, and
-- the packaging of information and guidance on conducting brief interventions into printed and on-line resources for doctors' use in clinical settings, together with materials (eg., literature) for patient use.

Taking direct and active approaches to promoting and raising awareness among GPs of evidence-based brief interventions.

Recommendation 3

The implementation of brief interventions by doctors could be made more effective through:

-- Stronger incorporation into medical training of brief intervention skills and techniques, including counselling and screening techniques;

-- Ongoing availability to doctors of continuing professional development in this area and availability of advice to doctors on best-practice prevention screening tools, and counselling skills and techniques.

Recommendation 4

The potential of brief interventions to motivate patients to self-manage their risk behaviour would be enhanced if:

-- Information was readily available to medical practices about programs, services and therapists in the local area that would be suitable as referral options, and

-- Evidence-based evaluations were conducted of the major publicly available programs for self-managing weight, smoking, and alcohol use, and information on the evaluation outcomes was made readily available to medical practitioners.

Recommendation 5

To improve doctors' access to important groups and individuals for early intervention, more public awareness and outreach measures should be implemented that are targeted to adolescents, young people and other key groups to encourage them to routinely access doctors' services.

Recommendation 6

The most appropriate funding arrangements to support patient rebates for the flexible and efficient provision of preventative interventions in medical practice (initial intervention and any follow-up) will consist of:

-- Existing standard and long consultation items with improved indexation of patient rebates through the MBS to properly recognise the time spent on preventative health care;

-- Improved MBS arrangements to provide patient rebates for practice nurses conducting brief preventative health interventions or follow-up 'for and on behalf of' the patient's doctor; and

-- MBS arrangements that provide patient rebates for services provided by medical practices undertaking group educational and preventative health sessions.

Recommendation 7

Grant programmes for general practices should be established to support the development and implementation of whole-of-practice prevention measures and programs. These arrangements should involve a minimum of administrative and transaction costs for doctors and medical practices, and should be as available to smaller rural and regional practices as to others.

Recommendation 8

-- The AMA should be invited to quality assure public education and mass media campaigns regarding alcohol, smoking and obesity risks, with a view to the AMA providing professional endorsement of appropriate evidence-based campaigns;

-- Public education and mass media campaigns about these risks should recommend, where appropriate, that further advice be sought from a medical practitioner, and

-- A grant program should be developed to encourage and support preventative health outreach activities in the general community conducted by individual doctors, medical practices, or doctors' professional associations.

Australian Medical Association
http://www.ama.com.au