Why it’s time to prioritise preventive care

Smoking, drinking, over-eating and addiction – people are creatures of habit, and GPs have a key role in helping patients become aware of the consequences of unhealthy lifestyle choices. But the reality is, there are so many obstacles that stand in the way between doctor and patient to deliver preventive care.

MedicalDirector’s Chief Clinical Advisor and GP, Dr Charlotte Middleton, discusses.

GPs have a key role to play in preventive care

 There is ample research showing the importance of preventive care in optimising patient outcomes. And it is widely acknowledged that GPs, who see 85% of Australia’s population at least once a year, can make a significant, positive impact to their patients’ health outcomes with the right preventive care.

The World Cancer Day Organisation states over one third of cancers are preventable. It stresses increased awareness and accurate information and knowledge can empower all of us to recognise early warning signs, make informed choices about our health and lifestyle choices. Meanwhile a 2013 meta-analysis of 205,000 patients found that most patients attempt to lose weight after their doctors raise the issue.

Breaking bad habits

According to the RACGP’s Guidelines for preventive activities in general practice (the Red Book), approximately 32% of Australia’s total burden of disease can be attributed to modifiable risk factors. Yet worryingly, preventive intervention is the primary reason for only seven in every 100 clinical encounters.

So while the evidence points to a clear connection between preventive care and better patient outcomes, the reality is, there are so many obstacles that stand in the way between doctor and patient to deliver good preventive care.

First of all, people don’t like being told they’re ‘being bad’. Most people ingrained in habitual behaviour either fail to recognise something is wrong, or simply don’t like being told ‘off’ for their actions. This is heightened even further if there is a social stigma surrounding the issue or serious socio-economic factors at play.

Secondly, people don’t like generic advice that’s too impersonal or broad. In fact, an MJA study revealed that patients often found preventive advice too superficial, giving examples of broad statements around losing weight. The report revealed patients want specific advice or referrals to experts such as dietitians.

Other communication tactics to avoid include:

• Making broad, sweeping statements (eg: replace ‘cut down on drinking’ to ‘aim for 2 drinks a week’)
• Sensationalised, scare tactics, or focusing too much on the negative statistics
• Insulting ‘negative’ words (eg: replace the word ‘weight’ and ‘over-eating’ with ‘diet’ and ‘nutrition’)

Interestingly, a new report in the Australian Journal of General Practice (AJGP), ‘Quantifying the benefits and harms of various preventive health activities’, also highlights some of the harms caused by preventive care measures which GPs need to be mindful of. These include the risk of over-diagnosis or overtreatment, or not addressing the withdrawal symptoms of breaking certain habits like weight changes when quitting smoking.

Finding the right approach

This is where the RACGP’s Guidelines for preventive activities in general practice (Red Book) can help. It outlines some key techniques to help patients overcome resistance to change. In particular, it suggests providing motivational interviewing techniques for at-risk patients, to complement the ‘5 A’s Approach’:

• Ask– A systematic approach to asking all patients about their smoking, nutrition, alcohol and physical activity (SNAP), which may occur opportunistically as they present for other conditions and/or by recall for health checks.
• Assess– Assess readiness to change, and dependence (for smoking and alcohol).

• Advise – Provide brief, non-judgemental advice with patient education materials.
• Assist/agree – Work with the patient to set agreed goals for behaviour change; provide motivational interviewing; refer to telephone support services, group lifestyle programs or individual providers (eg dietitian or exercise physiologist); consider pharmacotherapy.
• Arrange – Regular follow-up visits to monitor maintenance and prevent relapse.

Studies also show that if doctors can draw on their own experience in combatting certain unhealthy habits, the approach is more likely to succeed as it gives a more ‘human element’ to the consult – rather than focusing on negatives or risks, which a patient may interpret as criticism or judgement.

Making time in the day for preventive care

While all the evidence points to the need for doctors to make preventive care a priority, the reality is, there’s a great disparity between the time that you need to do it and the time that you have in a day.

And there’s actually a cold truth behind the satirical study,  ‘Much to do with nothing: microsimulation study on time management in primary care’, which indicates we need to work an extra 6 hours a day to provide better preventive care.

Because the reality is, by the time you tend to your patients, follow up on test results, and then catch up on the paperwork out of hours, you’re likely to end up working around the clock. Otherwise your notes or results don’t get done, or your messages don’t get attended to. So how can we be smarter with our time, and make preventive care a priority?

The RACGP’s Guidelines for the implementation of prevention in the general practice setting (The Green book) is a good start. It helps GPs understand how to integrate these preventative techniques more effectively in your daily clinical practice.

Cutting down the micro-moments of practice inefficiency can also help open up more time for preventive care. Using electronic letter writing templates and electronic referrals, accessing patient files on the go via the cloud, automating workflow processes such as billing and reporting, are just some ways that can help shave the time wasted on administrative tasks so you can focus on your patients, not your paperwork.