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Annexure C (ii)(e)

 

 

 

 

Manuals

New Medicare rebate to encourage expansion of GP Care

Tools for GPs to use when providing lifestyle advice to patients re any of Five Lifestyle Risk Factors For Chronic Disease:

1. Quitting smoking, 2. increasing physical activity, 3. healthier diet, 4. maintaining healthy weight, 5. reducing alcohol consumption.

GPs are provided with Lifescripts Resource Kits which focuses on above five lifestyle risk factors for chronic disease.

 

National initiative being implemented through GPs -

I.        promoting risk factor management; and

II.       primary health care services. 

Lifescripts is a major component of the Community Awareness and Infrastructure Initiative - part of the Focus on Prevention Package in the 2003-04 Federal Budget.

The Lifescripts component has been enhanced and expanded with an additional $2.7m in 2006-07 Federal Budget - $5.5m over four years:

  • increasing the reach and use of the Lifescripts resources in general practice through the Divisions network;

  • enhancing GPs skills to assist patients with behaviour change using the Lifescripts resources; and
  • adapting the Lifescripts resources for use with Indigenous and culturally and linguistically diverse patients.

The Lifescripts Resource Kit makes it easier for GPs to manage lifestyle-related risk factors by providing a framework for:

  • raising and discussing lifestyle risk factors with patients;

  • advice in the form of a written script and associated patient education; and

  • referral to other providers to support healthy lifestyle.

Contains evidence-based tools that enable GPs to assist patients to modify their lifestyles:

  • Divisions of General Practice Resource Kit: a manual to assist Divisions incorporate Lifescripts within their activities and to provide support and guidance to general practices;

  • Practice Kit: posters, flyers and checklists for practice waiting rooms and a manual to assist general practices integrate Lifescripts into their activities; and
  • Risk Factor Resource Kit:
    assessment tools,
    lifestyle prescriptions; and
    5As guideline cards for each risk factor.

The consumer resources include posters for practice waiting rooms, flyers and checklists to inform patients about the initiative and provide them with an opportunity to identify to their GP if they wish to discuss lifestyle risk issues. Separate Indigenous specific posters and flyers provide a more culturally targeted message for interested practices and Aboriginal Medical Services.

 The key practitioner resources are the 'Lifescripts script pads' which resemble normal prescription pads. General practices can obtain five different script pads, addressing smoking, alcohol consumption, nutrition, physical activity and weight management on which they can write lifestyle advice tailored to each patient’s needs. They can also use the pads to refer patients to other services, where available, to further support healthy lifestyle choices. In conjunction with the script pads, assessment tools and guidelines for each risk factor are provided along with key articles and evidence supporting the links between risk factors and disease.

An educational CD Rom is included in the Lifescripts Practice Kit to assist and enable GPs and other practice staff to train in motivational interviewing techniques, to improve their ability to encourage behaviour change in their patients. To order a copy of the CD Rom download the CD Rom Order Form.

Lifescripts Resources

Consumer Resources

Practitioner Resources

Lifescripts CD Rom

Manuals

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Implementation of Lifescripts

The Lifescripts initiative is being implemented via the Divisions of General Practice network. State Based Organisations (SBOs) provide ongoing support to Divisions in the use of the Lifescripts Resource Kit and in turn, participating Divisions can train interested practices, GPs, practice staff and Aboriginal Health Workers.

There is also a Lifescripts Coordinator at the Australian Divisions of General Practice (ADGP) whose role is to ensure that the Lifescripts initiative is implemented effectively by the Divisions network and integrated with existing prevention work.

The ADGP website contains a sub-page on the Lifescripts initiative and information on the implementation of the Lifescripts initiative in the Divisions network.
 

Australian Better Health Initiative

In February 2006 the Council of Australian Governments announced funding of $500 million for the Australian Better Health Initiative (ABHI) incorporating Five Priority Areas For The Australian Better Health Initiative.


The Lifescripts initiative relates to the majority of activities planned under the COAG Australian Better Health Initiative. The Lifescripts resources assist GPs, practice nurses and Aboriginal Health Workers to conduct lifestyle assessments, including the 45 year old Health Check, and provide advice and referrals on risk modification.

Current Projects as at November 2006

Community Health Risk Factor Management Research Project - NSW - collaborative project between Health & Ageing and NSW Dept of Health

Motivational Interviewing Techniques

Motivational Interviewing Technique and Stages of Change Model

Motivational interviewing is a style of counselling that prepares patients for behaviour change. Using the technique clinicians encourage patients to identify lifestyle behaviours that they would like to change and to articulate the benefits and difficulties of making that change. They allow patients to argue for their own change, rather than convince them of the need to change. Clinicians can then assist the patient to think of ways to overcome any barriers and set realistic targets for changing their behaviour.

During the past decade, behaviour change has come to be understood as a process of identifiable stages through which patients pass. The ‘Stages of Change Model’ describes and explains each of the stages. The model is based on the premise that behaviour change is a process, not an event, and that individuals have varying degrees of motivation or readiness to change.

The model identifies five basic stages of change. People move from being uninterested, unaware or unwilling to make a change (pre-contemplation), to considering a change (contemplation), to deciding and preparing to make a change (determination/preparation). Genuine, determined action is then taken (action) and, over time, attempts to maintain the new behaviour occur (maintenance). Relapses are almost inevitable and become part of the process of working toward life-long change (relapse).

As demonstrated in the diagram below, the model is circular rather than linear, as people can enter or exit at any point.


Motivational interviewing is particularly appropriate when people are at the pre-contemplation or contemplation stages but can be used whenever someone is feeling ambivalent. The method involves non-confrontational questioning, reflective listening, and summarising. Motivation emerges from the interpersonal interaction between the patient and the counsellor.
The clinician’s role is to facilitate the change process for the above displayed Five Basic Stages Of Change by:
  • Expressing empathy: listening and reflecting the patient’s concerns, thoughts and feelings in a non-judgemental manner.
  • Developing discrepancy: highlighting discrepancies between patient’s current behaviour and their other goals.
  • Avoiding argumentation and rolling with resistance: not arguing when patients are defensive or resistant, instead using active listening and reflection to avoid increasing their resistance
  • Supporting self-efficacy: supporting the person’s confidence in their own ability to achieve their goals.
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Links to further information on motivational interviewing

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Completed Projects

Development of a Resource Guide to Support the Implementation of the Lifestyle Prescriptions Initiative

In January 2005, the Department engaged a consortium to develop a resource guide to support the implementation of lifestyle prescriptions. Members of the consortium were Kinect Australia (formerly VICFIT), Centre for GP Integration Studies (University of NSW), National Heart Foundation, University of Newcastle (School of Health Sciences), Flinders University (Department of General Practice) and Southcity GP Services. The consortium’s work is now finalised, with the Lifescripts Resource Kit available to GPs through Divisions of General Practice. For more information and copies of resources see the section above, Lifescripts Resource Kit.

Scoping of Supporting Tools and Resources Project - Final Report

A project was undertaken to scope supporting tools and resources that would assist GPs and Divisions of General Practice to provide lifestyle advice to their patients through lifestyle prescriptions.

Through a tender process the Department of Health and Ageing engaged Market Access Research and Consulting to conduct the scoping project and obtain the required information from grass roots stakeholders including: Divisions of General Practice, Aboriginal Medical Services, GPs and general practice staff and Aboriginal Health Workers. The findings from this project are available in the final report (Scoping Supporting Tools for the Implementation of Lifestyle Prescriptions ( PDF 886KB )).

Lifestyle prescriptions workshop
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Publications and Reports

Budget 2006-2007: Fact Sheet: Lifescripts – increased funding

Improving Population Health outcomes through Partnerships with General Practice
The Joint Advisory Group (JAG) on General Practice and Population Health operated between 1999 - 2004 to provide advice on opportunities to enhance the population health role of general practitioners (GPs). The establishment and work of JAG derived from recommendations made in the General Practice Strategy Review, General Practice: Changing the Future through Partnerships Report.

Guidelines for preventive activities in general practice (the Red Book)
The recommendations in these guidelines are based on current evidence based guidelines for preventive activities.

National guide to a preventive health assessment in Aboriginal and Torres Strait Islander peoples is an initiative of the National Aboriginal Community Controlled Health Organisation (NACCHO) and was prepared by NACCHO as lead agency with the Chronic Disease Alliance (CDA) of Non-Government Organisations. The RACGP supported the development of this guide. The National guide assists GPs and primary health care providers to provide a comprehensive preventive health assessment to Aboriginal and Torres Strait Islander children and adults.

National Chronic Disease Strategy

In November 2005 the Australian Health Ministers’ Conference (AHMC) endorsed a national strategic policy approach to manage and improve chronic disease prevention and care in the Australian population. The proposed national approach to chronic disease prevention and management comprises three complementary components:
  1. The National Chronic Disease Strategy
    provides an overarching framework of national direction for improving chronic disease prevention and care across Australia;
  2. Five supporting National Service Improvement Frameworks
    have been developed for: asthma; cancer; diabetes; heart, stroke and vascular disease; and osteoarthritis, rheumatoid arthritis and osteoporosis.
  3. The Blueprint
    for nation-wide surveillance of chronic diseases and associated determinants.
Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting (the Green Book)
These guidelines are intended to be a practical resource for the strengthening of prevention activities in general practice. They provide a framework and a range of effective strategies to improve prevention activities.

Smoking, Nutrition, Alcohol and Physical Activity (SNAP) Framework for General Practice. Integrated approaches to supporting the management of behavioural risk factors of Smoking, Nutrition, Alcohol and Physical Activity (SNAP) in General Practice ( PDF 139KB )
The SNAP Framework was developed by the Joint Advisory Group on General Practice and Population Health (JAG), in conjunction with Chairs of National Population Health Strategies, to guide the implementation of integrated approaches to behavioural risk factor modification in general practice focusing on smoking, nutrition, alcohol and physical activity (SNAP).

SNAP A Population Health Guide to Behavioural Risk Factors in General Practice
The RACGP launched the SNAP (smoking, nutrition, alcohol and physical activity) a population health guide to behavioural risk factors in general practice on 3 October 2004. This guide contains current best practice clinical and business strategies for supporting patients to change their risk factor status in the general practice setting.
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Australian Links

  • Australian Divisions of General Practice - Australian Divisions of General Practice (ADGP) is the peak national body representing 120 Divisions of General Practice and 7 State Based Organisations across Australia, and was established in 1998.
  • ADGP Lifescripts webpage - The Department of Health and Ageing has funded a Lifescripts Coordinator at the ADGP whose role is to ensure that the initiative is implemented effectively and integrated with existing prevention work. The ADGP websites sub-page on Lifescripts contains information on the implementation of the Lifescripts program in the Divisions network.
  • Kinect Australia (formerly VICFIT) - Kinect Australia (incorporating VICFIT in Victoria) was established through the Ministers for Sport and Recreation and Health in March 1982 to provide advice to government and to coordinate the promotion of fitness/physical activity in Victoria.
  • Active Script Program - The Active Script program began in 1999, aimed at increasing the number of Victorian General Practitioners who deliver timely and effective physical activity advice to their patients. The program is funded by the Department of Human Services and the Australian Government Department of Health and Ageing and is one of a variety of integrated physical activity programs offered by VICFIT.
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International Links

  • Green Prescription: The Active Way to Health - The Active Living team works with people in the community who are not in schools or sports clubs. The aim is to improve the region's health by encouraging everyone to be physically active. Programmes include Green Prescription, Kiwi Walks, Kiwi Seniors, Project Champions and He Oranga Poutama. 
    The team promotes the PUSH PLAY philosophy, which is based on findings in the United States Surgeon General's 1996 report. This stated that significant health benefits could be obtained by including a moderate amount of physical activity (e.g. 30 minutes of brisk walking, 15 minutes of running or 45 minutes of playing volleyball) on most, if not all, days of the week. Additional health benefits can be gained through increased activity or more intense physical activity.
  • Green Prescription Resources - Getting enough activity into our lives can be as easy as a trip to the doctor or practice nurse in New Zealand. It's a great kiwi invention called the Green Prescription that has won international praise as a model to help fight the growing problems of inactive lifestyles and overindulgence. Once a doctor or practice nurse has prescribed an activity that will best suit their patient, it is the Active Living team's job to provide them advice, encouragement and motivation.
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