Implementation of a SNAP intervention in two divisions of general practice: a feasibility study

Abstract

Smoking, poor nutrition, risky alcohol consumption and decreased physical activity are major contributors to the burden of chronic disease in Australia.1 The 2003–04 BEACH (Bettering the Evaluation and Care of Health) report found that 34.5% of general practice encounters were with patients who were overweight, 22% with those who were obese, 26.7% with those who drank alcohol at risky levels and 21.9% with those who smoked.2 Although certain interventions have been shown to be effective in addressing these risk factors in general practice,3-6 few encounters involved risk-factor intervention, signifying an important gap between opportunity and practice.7,8 In 2003, the Australian Government developed a strategic framework for addressing smoking, nutrition, alcohol and physical activity (“SNAP”)9 in general practice. The 2002–03 Annual survey of divisions of general practice showed that more than half the divisions of general practice (DGPs) had programs focused on one or more of the SNAP risk factors.10 However, although there are national programs for chronic diseases such as diabetes, no specific national SNAP initiative has been established and there have been no published studies of its implementation in Australia. In 2003 and 2004, NSW Health funded a feasibility study on the SNAP approach to behavioural risk factor management in one urban and one rural DGP. The objectives were: • to test the feasibility and cost of a DGP program to support practices to systematically provide behavioural interventions for patients with SNAP risk factors in general practice; • to determine any change in the capacity and self-reported care provided by general practices; and • to identify lessons for other DGPs and for implementing the SNAP framework.