Evaluating the use of health checks by general practices in north Queensland

1. Evaluating the use of health checks by general practices in north Queensland Tracy Cheffins Margaret Spillman PHCRED, James Cook University, Townsville

2. Aims • To show whether patients receiving health assessments had better screening rates than those receiving usual care. • To engage practice nurses in a key role within a practice–based research project

3. NQPBRN • North Queensland Practice Based Research Network includes practices in Mackay, Cairns and Townsville. • Nurses receive training, practice visits, and financial support. • Projects developed in discussion with GPs and nurses.

4. Enhanced primary care (EPC) project • Four practices involved • Ethics approval through JCU HREC • Training day for nurses November 2008 • Site visits by TC January 2009 • Data collection Jan-March 2009 • Data analysis April 2009

5. Methods • Historical cohort study • Practice search on health assessment item number/s to find up to 100 completed in last 2 years. • Controls were those in same age group without a health assessment completed • Manual audit of medical records for recording of recommended screenings/interventions • GP & practice nurse questionnaire

6. Over 75 health check items • BP • Smoking status • Influenza vaccine • Pneumovax • Visual acuity • Urinalysis • FOBT/colonoscopy

7. 45-49 year old health check • This was originally in our research plan, but due to the small numbers done at 3 practices, was not continued

8. Results – over 75s

10. Practice surveys • Completed by each participating practice plus one new practice (n=5) • Explored processes used and attitudes to health checks • Input from both GP and practice nurse • Asked GPs most and least useful aspects and what unknown problems they had identified

11. Results of survey • 40-49 diabetes check is not done due to lack of understanding of the process • 45-49 age group check is thought to be too narrow for feasible application in GP • Both GPs and PNs recruit over 75s and recall systems are utilised • Two practices link 4 year old check to the immunisation visit

12. Overall value of HA • 4 year old and 45-49 year old checks are less likely to find problems because regular patients have had the checks already • 45-49 should be expanded to 40-60 and done every 5 years • Time consuming – registrars do them • Can provide a “second opinion” within the practice

13. Clinical issues • Incontinence • Complementary med’n interactions • Unsafe housing – falls prevention • Dental and nutrition problems • Dementia • Immunisations incomplete

14. Summary • Older patients who have not had a health assessment have significantly lower recording of recommended checks and preventative interventions. • Newer EPC items are not being utilised as much as the over 75 checks because of narrower criteria and poor understanding of the items

15. Authors’ acknowledgements • Practice nurses, administration, and GPs • DoHA funded PHCRED program – JCU • Dr. Clare Heal, Mackay • Ms. Robyn Preston, Townsville • Ms. Lorraine Taylor, Townsville