Turning the rhetoric into reality: Prevention and early intervention in HealthOne NSW services

Janet Anderson noted that prevention/early intervention is one of the challenging elements of the HealthOne NSW model. In terms of health promotion work there are differing opinions and tensions about the role of Government in intervening as a rule maker/regulator and the role of the individual in making choices about their health.

Janet presented the framework developed by the National Public Health Partnership as one way of thinking about prevention. In this framework, primary prevention effort is focused on the essentially well population, secondary prevention effort on people with existing risk factors and tertiary prevention effort on preventing complications for those with established chronic disease.

Janet referred to the recent paper published by the National Preventive Health Taskforce - Australia: The healthiest country by 2020. The Taskforce has taken as its first priorities overweight and obesity, tobacco and alcohol. In relation to the role of primary care in prevention, the discussion paper suggests there is a need to: define the population that the practice is working with and for, provide incentives for primary care involvement in preventive health activities and establish accountability and reporting for prevention.

Existing prevention activities that HealthOne NSW services have linked into or developed were identified during the discussion. These included the Koori Lifestyle Club in SWAHS, shared antenatal care at HealthOne Mt Druitt, opportunistic health screening at local community festivals in SSWAHS, diabetes evening session during Diabetes Week at HealthOne Elderslie, and implementing materials from state and national social marketing campaigns.

General practice and community health need to communicate with each other about existing prevention initiatives and how these programs can be brought together in a coherent way and provide the maximum benefit for clients.

A solid evidence base for prevention work is needed. To be successful, health promotion strategies needed to be based on an analysis of local needs and stakeholder perspectives.

Child and family health and the importance of HealthOne NSW services working in a prevention capacity with families at risk was identified by a number of participants. GPs find it difficult to provide the time needed for these clients. SWAHS has employed a GP Liaison Nurse with a focus on child and family health. This nurse plays a strong support role within HealthOne Mt Druitt. There was some discussion about the role for HealthOne NSW in reaching the "unworried unwell". While there is good evidence for primary prevention the question remains about whether there are sufficient resources available to enable primary prevention activities in a HealthOne NSW setting.

Staff from Molong talked about using the Commonwealth funding they had received for the Family Links program to set up a supported playgroup with a speech therapist and occupational therapist in attendance for single mothers in the local area. These single mothers were not necessarily linked in to a GP but have accessed HealthOne Molong through the Council run playgroup.

Staff from HealthOne Rouse Hill indicated that while it would be ideal to reach the "unworried unwell", they felt that this client group may not need highly integrated care and may be better suited to a general practice setting. The first priority group for HealthOne Rouse Hill is people with chronic disease who are frequent attendees of the hospital but could be managed better in the community.

From the Molong and Rouse Hill commentaries it was evident that while the general practice component of a HealthOne NSW service was well placed to deliver opportunistic and relatively uncomplicated prevention interventions, other health professionals/services as well as community care services were well placed to identify people in need of these interventions.

There was discussion about the importance of equity in relation to prevention efforts and working with those most in need. Principles of equity underpin AHS decisions about targeting specific disadvantaged populations for example. General practice cannot be selective about its patient population. This could present challenges in providing integrated prevention programs.

Additionally, workloads carried by primary and community health staff could be inimical to introducing an increased focus on primary/secondary prevention. In this regard, it was felt important to consider where the prevention effort is best spent.

Selecting a small number of key target areas related to the various levels of prevention (which may be different for each HealthOne NSW) was considered, as was HealthOne NSW services working with community groups, NGOs and peer education programs in primary prevention.

HNEAHS recently undertook a review of diabetes services. The Divisions of General Practice within HNEAHS felt that some aspects of diabetes care could be handed over to general practice.

This raised the possibility of reviewing the roles of general practice and community health in relation to specific populations and clinical pathways, to build prevention into all roles within a HealthOne NSW context.

This led to discussion about what is a reasonable expectation for HealthOne NSW services so that they are not overwhelmed by the prevention imperative. A final suggestion (for this session but indicating further discussion is required) was to consider what prevention work can be completed by integrated primary care services, such as HealthOne NSW, that others are not in a position to undertake.