Authors: Beattie J, Binder M, Harrison C, et al.
Reference: Aust Fam Phys. 2017 Oct; 46(10):751-755.
Summarised on: 17 May 2018
This article considers the prevalence of lifestyle risk factors (ie obesity, smoking and alcohol consumption) in general practice in Australia and the rates of corresponding clinical advice and counselling. It notes that GPs advice and counselling on modifiable lifestyle risk factors can have a positive effect.
However, while GPs are likely to ask and assess lifestyle risk factors (ie achieve the first two steps of the 5As approach), they might find it more challenging to advise, assist and arrange (ie the remaining three steps of the 5A approach).
The researchers analysed data from the Bettering the Evaluation and Care of Health (BEACH) program from April 2011 to March 2015, and compared general practice patients in three geographical areas: Western Victorian Primary Health Network (WV PHN), Victoria and Australia (PHNs are geographical areas established to facilitate better access to health services for patients, particularly population groups at risk of poorer health outcomes).
The BEACH program collected data from samples of 1000 GPs every year, providing parameters for 100 consecutive patient encounters.
The researchers found that rates of clinical advice and counselling for diet and exercise provided by GPs in the WV PHN network were significantly lower than Victorian and Australian rates, despite the WV PHN’s higher obesity rates (body mass index ≥35 kg/m2).
Smoking rates were higher in the WV PHN compared with Australia as a whole, but there was no difference in the levels of smoking cessation advice provided. Across all regions, one in four patients drank alcohol at hazardous levels.
Suggested barriers to obesity management in rural general practice included: less access to other health care professionals (eg dietitians), which limit opportunities for referral services and professional education; assessment and management of diet and exercise behaviours are time-consuming; clinical guidelines for obesity are complex and exhaustive; the maldistribution of the medical workforce results in increased wait times for appointments and decreased time with patients; and the ability to identify when a patient requires advice might be compromised because rural GPs see patients with higher BMIs more regularly.
The authors say there is a need for education and resources specific to rural GPs on managing patients who are obese, and a need to routinely record patients’ height and weight, and measure waist circumference to improve recognition of patients who require clinical counselling. GPs should also routinely record levels of alcohol consumption and provide smoking cessation advice.