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

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

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.

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

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

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

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

Results – over 75s HA completed (n= 294) HA not completed (n=301) Health assessment items % with item recorded p value BP Smoking status <.001 Influenza vaccine Pneumovax <.001 Visual acuity <.001 Urinalysis <.001 FOBT/colonoscopy

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

Results of survey diabetes check is not done due to lack of understanding of the process 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

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

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

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

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