ATSI Health assessment – 15-54 age

Systems approach:

• Eyes / Ears / Dental
• CVD / Murmurs
• Haem / anaemia
• Kidneys
• Cancer Surveillance
• Mental Health / suicide prevention
• Sexual health / pregnancy
• Vaccination
• SNAP
• Additional PBS benefits (nicotine patches, bupropion, varenicline)

COMPONENTS OF THE HEALTH CHECK

• Information collection
• Assessment of the patient
• Interventions as indicated
• Advice and information to the patient

1. Information collection
   1. History
      • Patient medical history and current health problems
      • Family medical history
      • Lifestyle risk factors (eg smoking, physical inactivity, poor nutrition, use of alcohol and other substances)
      • Medication usage
      • Immunization status
      • Psychosocial (eg depression and risk of self-harm)
      • Sexual and reproductive health
      • environmental and living conditions
        • crowded living
      • family relationship
        • does the patient care for someone else
      • SNAP hx
        • smoking status: quitting stage:
        • nutrition
        • alcohol and other substance use
        • physical activity
   2. Examinations (as clinically relevant)
      • Blood pressure:  pulse rate and rhythm
      • Weight: height: bmi: waist circumference:
      • Ear and hearing: otoscopy whisper test (if indicated)
      • Eyes
        • trachiasis (note: examine those people who have grown up in remote communities or have a history of ‘sore or watery eye’)
        • visual acuity (recommended for over 40’s)
      • Mood (depression and self harm risk)
      • Gums and dentition
   3. Investigations (as clinically relevant)
      • Fasting blood lipids
      • Fasting blood glucose
      • Pap smear
      • Testing for colorectal cancer and breast cancer for at risk patients
2. Assessment of the Patient
   1. based on the history and results of any relevant examinations and investigations
   2. Assessment of the patient’s readiness to make lifestyle changes
3. Interventions & Advice
   1. Discuss results of health check and recommended future action with the patient.
      • Education, counselling or advice
      • Patient self-management
      • Initiation of treatment – this may include services covered by other MBS items such as attendance items, GP Management Plan and Team Care
      • Arrangement items, incentive items for the management of diabetes and asthma, mental health items, etc.
      • Referrals
        • smoking cessation services
        • diabetes services
        • local programs for physical activity,
        • home medicine review
        • 5 follow-up allied health services including:
          • Aboriginal health worker etc…
      • Ask them to return for follow-up services with the practice nurse to encourage medication compliance and give education and lifestyle advice under item 10987
   2. GPs are strongly encouraged to provide written information to the patient (including the use of the Lifescripts resources where relevant).

What to assess	How to assess	If risk is present
Smoking	Ask about smoking of cigarettes, pipes or cigars.	1. Assess readiness to quit smoking and nicotine dependence  2. Offer brief nonjudgmental advice to quit  3. Refer to the Quitline 131 848.	SNAP 10–13
Nutrition	Ask about the number of portions of fruit and vegetables eaten per day and the types of fat eaten.	All patients should be advised to follow the NHMRC Dietary guidelines for Australian adults	SNAP 17–19
Alcohol	Ask about the quantity and frequency of alcohol intake and number of alcohol free days each week	1. Try to reach agreement about the number of drinks per day and the number of alcohol free days 2. High risk situations should be identified and avoided and appropriate social support such as friends or family should be enlisted  3. Monitor progress at a follow up visit.	SNAP 20–23
Physical activity	Ask how many minutes per day of moderate physical activity	Advise to participate in 30 minutes of moderate activity on most, preferably all days of the week.	SNAP 24–
Depression	Ask ‘Over the past 2 weeks, have you felt down, depressed or hopeless?’ and ‘Over the past 2 weeks have you felt little interest or pleasure in doing things?’	Check for suicide risk Consider counselling, cognitive behavioural therapy, pharmacotherapy or referral to psychologist	Red book 58–9
Osteoporosis	Ask about risk factors	Bone mineral densitometry Management of risk factors	Red book 66–7
Examination
Body weight	Assess body mass index and waist circumference	Develop weight management plan
Blood pressure	Measure blood pressure.	Assess absolute cardiovascular risk and consider referral or pharmacotherapy based on thisLifestyle risk factor counselling	Red book 38
Skin cancer	Examine skin if increased or high risk.	Provide preventive advice Manage according to risk	Red book 48–9
Tests
Lipids	Order fasting blood lipids.	Assess absolute cardiovascular risk and consider referral or pharmacotherapy based on this Lifestyle risk factor counselling	Red book 39–40
Diabetes	Consider ordering fasting blood glucose if at risk.	If diabetes, treat If IGT or IFG (pre-diabetes), offer early interventionLifestyle risk factor counselling.	Red book 41–2 2.
Cervical cancer	Pap test every 5 years for women who have ever had sex and still have an intact uterus.	Manage according to risk	Red book 49–50