Testing the effectiveness of supported referral to healthy lifestyle interventions in reducing the number of modifiable risk factors among primary care patients.

Eligible general practice patients will complete a brief (approximately 10 minute) touchscreen computer survey on a tablet device while in the waiting room prior to their appointment. The survey will assess whether the patient has modifiable risk factors related to: smoking, alcohol consumption and overweight or obesity using validated tools. Those who indicate that they have at least one of these risk factors will be eligible to participate in the trial. Patients who are randomised to the intervention condition will receive: (i) Tailored written feedback. A patient feedback sheet that is tailored based on the participants responses to the baseline survey will be automatically printed upon completion of the assessment using a dedicated printer located in the reception area. The feedback sheet will be handed to the patient when they return the tablet computer to the research assistant. The feedback sheet will include information about recommended preventive healthcare actions based on answers to the baseline survey. (ii) GP endorsement of feedback. The GP will emphasise the importance of preventive care in the patient’s appointment and will recommend that the patient book at reception for a face-to-face nurse consultation. If the patient forgets to make the appointment, the nurse will phone the patient to make the appointment. (iii) Face-to-face consultation with a practice nurse, involving risk counselling, motivational interviewing and provision of referral to evidence-based services. The nurse will provide a face-to-face consultation which comprises: 1) Review of identified risk factors including brief advice. The nurse will provide a brief verbal overview of what their feedback means, for example, how their risk factors compare to relevant guideline recommendations; the potential adverse health consequences associated with these, and what level of change would needed to make a difference to their health. 2) Assessment of patient interest in reducing their risk factors. To establish the patient’s motivation and confidence to make changes the nurse will ask how patients feel about making a change (e.g. quitting smoking, losing weight). The nurse will affirm and encourage patients interested in making a change. If the patient is not willing address their risk factors at this time, the nurse will arrange to follow-up with the patient in 4 weeks by telephone to see if they would be willing to consider a referral at this time. 3) Assessment of barriers/enablers to addressing risk factors. For those who are interested in addressing one or more risk factors, the nurse will elicit patient views about factors that may help or hinder them in making lifestyle changes. For example, knowledge about what strategies will work, social support, environmental triggers etc. 4) Referrals to external support services. The nurse will refer the patient to the “Get Healthy Service” call back service for overweight / obesity and/ or risky alcohol consumption. The ‘call back’ service involves the patient receiving a proactive telephone call from the service rather than the patient initiating contact. The Get Healthy Information and Coaching Service® (Get Healthy Service) is a free telephone service (phone: 1300 806 258) staffed by qualified health coaches that provides information and ongoing support to people in NSW aimed at changing an individual’s behaviour regarding healthy eating, physical activity, and how to reach and maintain a healthy weight. The Get Healthy Service has two streams: 1) information only (a one-time coaching call and printed information); or 2) 6 month coaching program (10 coaching calls over 6 months). The Get Healthy service will assign participants to the most appropriate stream dependent on participant preference and the health coach's recommendation. A Quitline call back referral will be made for those who report current smoking. Quitline is a telephone service (phone: 13 78 48) that provides information and advice or counselling to people in NSW who want to quit smoking. A free Quit Pack can be requested which includes: a Quit Book containing information on: the best way to quit, coping with withdrawal symptoms, proactive telephone counselling, and local organisations that can provide help and counselling; and a pocket guide with hints on how to stay a non-smoker. Participants with internet access will also be provided with information about QuitCoach, a free online tool to assist in quitting smoking. This service includes the development of a personalised quitting plan based on participant responses to questions about motivation, confidence and past attempts. http://www.quitcoach.org.au/ A referral to the GP may also be made if there are health conditions that need to be considered when making lifestyle changes (e.g. mobility issues, heart condition), and/or if a pharmacological intervention to assist with smoking cessation should be considered. For example, nicotine replacement therapy can be prescribed where appropriate. Post-consultation follow-up (two-weeks later) The nurse will also arrange a follow-up visit or phone call two weeks post face-to-face consultation to review how the plan is going, any issues experienced and if patient has received a call back or phoned the referral services suggested to them e.g. the Get Healthy Service or Quitline.