General practitioner assessment of lifestyle risk factors for chronic disease: a cross-sectional study in urban, rural and remote South Australia
Antoinette Liddell A * , Lucy Brown A , Susan Williams A and David Gonzalez-Chica BA Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia.
B Adelaide Rural Clinical School and Discipline of General Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia.
Australian Journal of Primary Health - https://doi.org/10.1071/PY23035
Submitted: 8 March 2023 Accepted: 25 May 2023 Published online: 23 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: The assessment and management of the SNAP lifestyle risk factors (smoking, nutrition, alcohol intake and physical activity) is fundamental to primary prevention of chronic disease. This study investigates the prevalence of SNAP assessments conducted in South Australian general practice, according to patient risk profiles, and across urban, rural and remote locations.
Methods: A cross-sectional population-based survey was conducted in South Australia in 2017. Survey data included information on health characteristics, lifestyle risks and general practitioner (GP) assessments for 2775 participants, aged ≥18 years, who visited a GP in the past 12 months. The main outcome measure was assessment for two or more (≥2) SNAP risks in this time. Logistic regression models were used to estimate the prevalence of ≥2 SNAP assessments by remoteness area, using the Modified Monash Model (MMM) classifications for urban (MMM), rural (MMM3-4) and remote (MMM5-6), and adjusting for sociodemographic, SNAP lifestyle risks and clinical variables.
Results: Of the 2775 participants (mean age 49.1 ± 18.7 years; 52.7% women), 32% were assessed for ≥2 SNAP in the past 12 months. The adjusted prevalence of assessments was higher in rural (43.8%; 95% CI 36.4–51.2%) than urban (29.7%; 95% CI 27.2–32.2%) or remote (34.7%; 95% CI 28.4–41.0%) areas. Depending on rurality, ≥2 SNAP assessments were 2.5–3.4 times more likely among participants with existing cardiovascular disease, and two to seven times more likely among participants with three or four SNAP risk factors (P < 0.05 in all cases).
Conclusion: Greater attention to GP SNAP assessments is warranted to match the prevalence of SNAP risks across South Australia.
Keywords: chronic disease, family practice, general practice, health risk behaviours, lifestyle risk reduction, primary prevention, rural health.
References
ABS (2016) Australian Statistical Geography Standard (ASGS): Volume 5 – Remoteness Structure, July 2016. (Australian Bureau of Statistics) Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.005 [Verified 10 December 2022]AIHW (2015) Cardiovascular disease, diabetes and chronic kidney disease – Australian facts: Risk factors. Cardiovascular, diabetes and chronic kidney disease series no. 4. Cat. no. CDK 4. Australian Institute of Health and Welfare, Canberra.
AIHW (2020) Insufficient physical activity. (Australian Institute of Health and Welfare: Canberra, Australia) Available at https://www.aihw.gov.au/reports/risk-factors/insufficient-physical-activity [Verified 24 August 2022]
AIHW (2021a) Australian Burden of Disease Study: impact and causes of illness and death in Australia 2018. Australian Burden of Disease Study series no. 23. Cat. no. BOD 29. Australian Institute of Health and Welfare, Canberra.
AIHW (2021b) Heart, stroke and vascular disease: Australian facts. (Australian Institute of Health and Welfare: Canberra, Australia) Available at https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts [Verified 24 August 2022]
AIHW (2022a) Rural and remote health. (Australian Institute of Health and Welfare: Canberra, Australia) Available at https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health#Health%20risk%20factors [Verified 7 September 2022]
AIHW (2022b) Diet. (Australian Institute of Health and Welfare: Canberra, Australia) Available at https://www.aihw.gov.au/reports/australias-health/diet [Verified 24 August 2022]
Allenby A, Kinsman L, Tham R, Symons J, Jones M, Campbell S (2016) The quality of cardiovascular disease prevention in rural primary care. Australian Journal of Rural Health 24, 92–98.
| The quality of cardiovascular disease prevention in rural primary care.Crossref | GoogleScholarGoogle Scholar |
Amoroso C, Hobbs C, Harris MF (2005) General practice capacity for behavioural risk factor management: a SNAP-shot of a needs assessment in Australia. Australian Journal of Primary Health 11, 120–127.
| General practice capacity for behavioural risk factor management: a SNAP-shot of a needs assessment in Australia.Crossref | GoogleScholarGoogle Scholar |
Anand SS, Islam S, Rosengren A, Franzosi MG, Steyn K, Yusufali AH, Keltai M, Diaz R, Rangarajan S, Yusuf S, INTERHEART Investigators (2008) Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. European Heart Journal 29, 932–940.
| Risk factors for myocardial infarction in women and men: insights from the INTERHEART study.Crossref | GoogleScholarGoogle Scholar |
Australian Bureau of Statistics (2011) Census of population and housing: Socio-Economic Indexes for Areas (SEIFA), Australia. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001 [Verified 13 September 2022]
Australian Government Department of Health (2021) Modified Monash Model. Available at https://www.health.gov.au/health-topics/rural-health-workforce/classifications/mmm [Verified 8 February 2022]
Beattie J, Binder M, Harrison C, Miller GC, Pedler D (2017) Lifestyle risk factors and corresponding levels of clinical advice and counselling in general practice. Australian Family Physician 46, 751–755.
Britt H, Miller G, Valenti L (2001) It’s different in the bush: a comparison of general practice activity in metropolitan and rural areas of Australia 1998–2000. General Practice Series No. 6. Australian Institute of Health and Welfare, Canberra.
Chan K, Xue H, Carlson J, Gray JM, Bailey J, Vines R (2022) Impact of COVID-19 on lifestyle and mental wellbeing in a drought-affected rural Australian population. Rural Remote Health 22, 7231
| Impact of COVID-19 on lifestyle and mental wellbeing in a drought-affected rural Australian population.Crossref | GoogleScholarGoogle Scholar |
Denney-Wilson E, Fanaian M, Wan M, Vagholkar M, Schutze H, Mark M (2010) Lifestyle risk factors in general practice – routine assessment and management. Australian Family Physician 39, 950–953.
Gonzalez-Chica DA, Dal Grande E, Bowden J, Musker M, Hay P, Stocks N (2017) Are we reducing the risk of cardiovascular disease and improving the quality of life through preventive health care? Results of a population-based study in South Australia. Preventive Medicine 99, 164–170.
| Are we reducing the risk of cardiovascular disease and improving the quality of life through preventive health care? Results of a population-based study in South Australia.Crossref | GoogleScholarGoogle Scholar |
Gonzalez-Chica DA, Bowden J, Miller C, Longo M, Nelson M, Reid C, Stocks N (2019) Patient-reported GP health assessments rather than individual cardiovascular risk burden are associated with the engagement in lifestyle changes: population-based survey in South Australia. BMC Family Practice 20, 173
| Patient-reported GP health assessments rather than individual cardiovascular risk burden are associated with the engagement in lifestyle changes: population-based survey in South Australia.Crossref | GoogleScholarGoogle Scholar |
Morris M, Halcomb E, Mansourian Y, Bernoth M (2022) Understanding how general practice nurses support adult lifestyle risk reduction: an integrative review. Journal of Advanced Nursing 78, 3517–3530.
| Understanding how general practice nurses support adult lifestyle risk reduction: an integrative review.Crossref | GoogleScholarGoogle Scholar |
National Rural Health Alliance (2017) The disproportionate burden of heart disease in rural and remote Australia. Available at https://www.ruralhealth.org.au/news/disproportionate-burden-heart-disease-rural-and-remote-australia-0
Ng R, Sutradhar R, Yao Z, Wodchis WP, Rosella LC (2020) Smoking, drinking, diet and physical activity – modifiable lifestyle risk factors and their associations with age to first chronic disease. International Journal of Epidemiology 49, 113–130.
| Smoking, drinking, diet and physical activity – modifiable lifestyle risk factors and their associations with age to first chronic disease.Crossref | GoogleScholarGoogle Scholar |
Passey M, Fanaian M, Lyle D, Harris MF (2010) Assessment and management of lifestyle risk factors in rural and urban general practices in Australia. Australian Journal of Primary Health 16, 81–86.
| Assessment and management of lifestyle risk factors in rural and urban general practices in Australia.Crossref | GoogleScholarGoogle Scholar |
RACGP (2015) ‘Smoking, nutrition, alcohol, physical activity (SNAP): a population health guide to behavioural risk factors in general practice.’ 2nd edn. (The Royal Australian College of General Practitioners: Melbourne)
RACGP (2016) ‘Guidelines for preventive activities in general practice.’ 9th edn. (The Royal Australian College of General Practitioners: East Melbourne, Vic.)
Rygh EM, Hjortdahl P (2007) Continuous and integrated health care services in rural areas. A literature study. Rural Remote Health 7, 766
Taylor A, Dal Grande E, Wilson D (2006) The South Australian Health Omnibus Survey 15 years on: has public health benefited? Public Health Bull 3, 30–32.
Wellbeing SA (2022) South Australian population health data. Available at https://www.wellbeingsa.sa.gov.au/evidence-data/explore-and-request-data/open-data-portal/south-australian-population-health-data [Verified 18 May 2023]
WHO (2003) Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. World Health Organization technical report series 916 Geneva. World Health Organization.
