NPS Medicinewise has launched a new program which focuses on quality use of medical tests in general practice, in particular when conducting health assessments in healthy asymptomatic patients between the ages of 40-49 years of age. This is a great opportunity for GPs and practice nurses to identify which patients are at risk of developing chronic diseases and to give them the opportunity to make lifestyle changes that will benefit them in the future.
Sally Herbert, local pharmacist and National Prescribing Service (NPS) facilitator has recently commenced educational visits to local surgeries delivering a program which details how tests are just one part of the story and are not infallible.
Obtaining a detailed clinical history and undertaking a physical examination and considering family history and lifestyle issues, will determine which patients are likely to benefit from which tests. NPS encourages GPs to prioritise the use of evidence based risk assessments such as the AUSDRISK tool for diabetes, and the Heart Foundation CVD Risk assessment tool, in order to determine which tests are appropriate in particular age groups, and to avoid inappropriate tests which may do more harm than good.
For example, harm can be caused by over diagnosis. A test may identify a condition that if left alone would not impact on a person’s health, but once investigated may lead to a series of other investigations and treatments with harmful side effects. General practice has the opportunity to make a difference through targeted preventive health activities that include appropriate testing.
While lipid testing as part of a CVD Risk Assessment, and Pap testing for cervical cancer, are both supported by evidence, PSA, Thyroid Function testing and Vitamin D testing are not well supported as routine tests in healthy patients with no symptoms or risk factors.
The Cancer Council has published a PSA decision tool to help GPs have the conversation with patients by weighing up the benefits and harms. NPS has also developed an Over the Counter Vitamin D Supplements fact sheet which may be useful for patients who may be considered at risk of low vitamin D, as supplementation without testing may be appropriate in some patient groups.
Brief lifestyle interventions in general practice can make significant differences. Northern Rivers weight watchers meetings and NSW Health funded Get Healthy Program are two referral options GPs may choose for patients that are contemplating lifestyle change to improve their diabetes and overall CVD risk.