1. Health Promotion in Primary Care
Dr Lola Savage
15th February 2012

2. AIM To increase awareness of health promotion in General practice
Case presentation
NHS health Check
Questions-Single best Answer

3. GP Curriculum
Healthy people: promoting health and preventing disease

4. Definition
WHO: Health promotion is a process of enabling people to increase control over and to improve their health

5. Prevention
Health Professionals-we aim to prevent diseases in our patients
Prevention can be classified into the following:
Primary prevention
Secondary prevention
Tertiary prevention
Which of the above categories do we spend most of our time doing?

6. Primary prevention
What health promotion activities do we currently advocate in primary care?

7. Primary Prevention New Patients Well woman and well man clinics
Immunisations
Travel advice
Screening programmes- cervical/mammogram/STI

8. New patients health check
Urinalysis
BMI
Blood pressure
Smoking status
Exercise
Alcohol screen-Audit C
Family hx
Ethnicity
Health ed- diet/ exercise-recorded
Well woman/men check:
Smear status

9. How do we as GP registrars incorporate primary prevention into our practice?

10. How can we incorporate health promotion into our consultations
Medication review-review summary records- alcohol intake/BMI/cholesterol/renal function
Pill check-promote LARC
Adhere to prompts for QOF- e.g smoking/ blood pressure reading
Pregnant patients-folic acid/blood pressure/alcohol/smoking/diet/vit D/refer to community midwife
? Promote NHS health checks

11. Case Presentation
53 man who presented with a 12 week history of Left foot pain following a car going over his foot in a motorcycle event. X-ray left foot-NAD
PMH- Essential Hypertension
DHx-Amlodipine 5mg od (last issued may 2010)
SHx- Runs his own company. Doesn’t smoke
What should I do next?

12. Case Presentation
Took brief hx of the pain/ex his left foot and decided to refer him for physiotherapy
Establish a rapport with him and explored his ideas about his medical hx and non compliance with medications
Clinic blood pressure readings: 174/85, 162/93

13. Case Presentation
Arrange for him to do home readings for a week and to review again
Average home readings-156/90
Reviewed risk- bloods- cholesterol/renal function/glucose
Q-risk- 9.5%
Nice guidelines- ACEI- ramipril
Reviewed in 1/12- bp 130/86
Follow up- pt applied for health insurance- declined-previous hx of non-compliance to meds

14. NHS health check Background
Heart disease/ Stroke /Diabetes and kidney disease are the biggest cause of death in the UK
4 million of people in the UK affected
170,000 people die each year in England from these conditions
Health inequalities in deprived areas and in certain ethnic groups
2008-DoH published ‘Putting Prevention First’ –sets out a systematic and integrated approach to assess individuals between 40-74
This National Screening Programme is known as Health Checks- due to be rolled out by PCTs in 2012/2013

15. NHS health check
Invites patients ages who are not known to have DM/CVD/TIA/ MI/HT once every 5 years
Fixed factors-Age/ Gender/Ethnicity

16. NHS health checks
Aims
To identify patients at risk of developing MI/CVA/TIA/Diabetes/HT
To sustain increase in life expectancy
To reduce premature death associated with obesity/sedentary life
Reduce health inequalities
Reduce the cost of long term ill health on the NHS

17. What does it look like?

19. Questions-Single best Answer

20. 1 Which of the following statements does not apply to the Cardiovascular Disease Screening Programme?
a) Cardiovascular disease screening will identify risk factors that will contribute to
vascular disease
b) Early intervention can reduce the onset of vascular disease
c) Cardiovascular Disease screening will support patients who have had a heart attack.
d) Cardiovascular Disease screening can prevent and in some circumstances reverse the onset
of vascular disease
2 For what age group is the National Cardiovascular Disease screening programme recommended?
a) 20yrs- 40yrs
b) 30yrs- 64yrs
c) 35yrs- 65yrs
d) 40yrs- 74yrs
3 Which of the following blood pressure measurements would you refer your client to their GP?
a) 130/75
b) 130/85
c) 140/85
d) Above 140/90

21. 4 Which of the following risk factors can be modified or potentially reversed in the Cardiovascular Disease Screening process?
a) Age
b) High Blood pressure
c) Ethnicity
d) Family History Cardiovascular disease
5 Which of the following conditions will not affect a patient’s Cardiovascular Disease risk calculation?
a) Smoking
b) Elevated BP
c) Diabetes
d) Alcohol
Why would a 45 year old male who smokes, has a blood pressure of 160/90, Total Cholesterol/ HDL ratio of 6.0 and a BMI of 27.7 have a low CVD QRISK Risk Score of 8%?
a) They drink above the recommended 21 units of alcohol per week
b) They have Asthma
c) Because he is 45yrs old
d) Because he has Diabetes

22. 7 Lifestyle advice/or referral as part of the NHS Health Check is important because….
a) Fresh air is good for everyone
b) It offers patients the opportunity to make lifestyle changes that will improve their health
c) It looks good for the practice
d) The government thinks it’s a good idea.
8 When should a patient be sent for a fasting blood glucose test for assessment of Diabetes through NHS Health Checks?
a) BMI is in the obese range >30
b) Blood pressure is at or above 140/90, or where the SBP or DBP exceeds 140 or 90
respectively.
c) The patient has a BMI >27.5 and is either Indian, Pakistani, Bangladeshi, Other Asian or
Chinese
d) All the above

23. Summary Increase awareness of health promotion in primary practice
Case presentation
NHS health checks

24. Any questions?

25. Thank you

26. References
Putting prevention first. Vascular checks: risk assessment and management
Oxford handbook of GP