45-49 Year Old Health Check

RACGP - CLINICAL RESOURCES
45-49 YEAR OLD HEALTH CHECKS

From 1 November 2006, a new Medicare item is available for a 45 year old health check. This is available as a once only service to patients aged 45 to 49 years (inclusive) who are at risk of developing a chronic disease.

The health check will assist with the detection and prevention of chronic disease, and enable early intervention strategies. A patient must be at risk of developing a chronic disease, and the general practitioner must identify a specific risk factor. Factors that may be considered include lifestyle risk factors, biomedical risk factors and family history. It is likely that a large proportion of patients within the eligible age range will already have a risk factor for chronic disease. The Australian Institute of Health and Welfare estimates that 94% of males and 89% of females in the 45-54-age range have at least one risk factor for cardiovascular disease.1 Almost one in four Australians 25 years and over has either diabetes or impaired glucose metabolism, which increases the risk of heart disease and diabetes later in life.2

IDENTIFYING ELIGIBLE PATIENTS

A large proportion of patients who may be at risk may not be identifiable by the practice. Age, sex and medications are usually reliably recorded by practices, allowing for identification of suitability for screening for blood pressure, lipids, and pap smears etc. Patients who have conditions such as diabetes and hypertension can also be identified from their medications. However, weight is currently recorded in less than 50% of patients, and height, body mass index and waist circumference are only recorded in about 20% of patients. Smoking status and alcohol consumption are recorded less than 50% of the time, and diet is recorded in less than 10% of patients. Even where the information is recorded, most current practice software systems do not have the ability to recall the information required to identify eligible patients.

The practice team can work together to identify eligible patients in their practice. Some suggested methods include:

Proactive identification:

  • Where practice staff are able to identify risk factors, writing to eligible patients with information about the health check.
  • Writing to all patients aged 45-49 informing them of the health check and asking them to make an appointment if they think they have a risk factor. The GP would then need to confirm that the patient has a risk factor and if so undertake the health check in the same visit, or determine whether the patient has a risk factor as part of a consultation (billed under the appropriate item) and if so, undertake the health check during a subsequent visit.
  • Targeting male patients within the practice, as men are more likely to have a risk factor and less likely to visit the GP frequently.

Opportunistic identification:

  • Discussing the health check opportunistically with patients within the age range as they attend and identifying risk factors during a normal consultation.
  • Reception staff or practice nurses could flag patients visiting the practice within the age range, and give them the patient practice prevention survey to identify risk factors.

Providing information and raising awareness:

  • Providing information on the health check in the waiting room.
PATIENT READINESS TO CHANGE

In many cases, the advice provided to patients undergoing the health check will require behavioural change to reduce the impact of risk factors.

General Practitioners may wish to refresh their knowledge on assessing how ready patients are to change their lifestyle. The ‘stages of change’ model may assist in determining the best management approach. For patients who are not confident about their ability to succeed, information and reassurance about their likelihood of success and the support available should be given. For patients who are ready to make a change, time can be spent explaining and planning how to make that change. The RACGP SNAP Guide and Green Book provide guidance on assessing readiness to change and how to approach motivational interviewing.

REFERRALS

It is anticipated that preventive screening will generate an increased number of referrals and will significantly affect the demand for other services, both public and private, such as physical activity programs, and advice on healthy diet and weight loss. During the consultation process, the RACGP recommended that strategies be implemented to manage the additional referrals that will be generated, to ensure that those who need further assistance are able to access it.

Prior to undertaking the health checks, it might be useful to investigate what services are available in your local area and how accessible they are to patients. A directory of referral information within the practice should include counselling and self-help groups for smoking cessation, dietician referral information, drug and alcohol counsellors and self-help groups, local programs and services for physical activity, and more specialised services such as diabetes services. Divisions of General Practice will be able to provide some information. The RACGP SNAP guide includes contact details for a number of national services for behavioural risk factors.

1. AIHW: O’Brien K 2005. Living dangerously: Australians with multiple risk factors for cardiovascular disease. Bulletin No. 24. AIWH Cat.No.AUS 57. Canberra: AIHW.
2. Zimmet P. Diabesity in Australia: An affair of the heart. Heart Lung Circ. 2003;12 Suppl 2:S95-8
3. racgp, publications, guidelines  

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