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Health Promotion and Patient Education

Last updated 31 May 2026 Β· General Practice

πŸ“‹ Key Information Summary

πŸ“‹
  • Health promotion in general practice is a core component of the Australian primary care model, embedded in the RACGP Standards for General Practices (5th edition) and funded through MBS Health Assessment items.
  • The SNAP framework targets the four leading modifiable behavioural risk factors: Smoking, Nutrition, Alcohol, and Physical inactivity β€” responsible for an estimated 32% of Australia's total disease burden (AIHW 2024).
  • The 5As model (Ask, Assess, Advise, Assist, Arrange) provides a structured, evidence-based brief intervention framework applicable to any behavioural risk factor and is recommended by the RACGP and U.S. Preventive Services Task Force.
  • The NEAT Guide (Nutrition, Exercise, Alcohol, Tobacco) is a practical GP desktop reference for opportunistic screening during routine consultations.
  • MBS Item 701 (brief health check), 703 (standard health assessment), and 705 (prolonged health assessment) remunerate structured preventive health assessments, including Aboriginal and Torres Strait Islander health checks (MBS Items 715).
  • Evidence supports that even 3–5 minute brief interventions in general practice produce clinically significant behaviour change, particularly for smoking cessation (NNT ~20) and harmful alcohol use.
  • Australia's Australian Guide to Healthy Eating (AGHE) and the 2021 National Obesity Strategy provide population-level nutrition and physical activity targets that GPs should reinforce.
  • Psychosocial health promotion β€” including screening for depression (PHQ-9, K10), domestic violence, and social isolation β€” is integral to holistic general practice care.
  • Lifestyle medicine interventions in primary care can reduce cardiovascular risk by 20–30% over 5 years and are cost-effective versus pharmacological monotherapy for mild hypertension and dyslipidaemia.
  • Aboriginal and Torres Strait Islander Australians experience 1.6Γ— the rate of behavioural risk factors compared with non-Indigenous Australians; culturally safe, strengths-based approaches using the 715 Health Check are essential.
  • Patients should be offered referral to allied health providers (dietitians, exercise physiologists, psychologists) under Medicare-funded Chronic Disease Management plans (MBS Items 721–732) where risk factors are identified.
  • Electronic health records and clinical decision-support tools (e.g., PEN Clinical Audit Tool) enable population-level auditing of preventive care delivery against RACGP benchmarks.

Introduction & Australian Epidemiology

General practice is the cornerstone of Australia's primary healthcare system, with approximately 87% of Australians visiting a GP at least once annually. The general practice setting is uniquely positioned to deliver health promotion and patient education because of its longitudinal, trusted relationship with patients, high consultation frequency, and capacity for opportunistic screening. The RACGP Standards for General Practices (5th edition) mandates that practices systematically identify and manage preventive health care needs.

Chronic diseases β€” cardiovascular disease, type 2 diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and certain cancers β€” account for approximately 87% of deaths and 77% of the total disease burden in Australia (AIHW 2024). The majority of this burden is attributable to modifiable behavioural risk factors that are amenable to intervention in the general practice setting.

Risk Factor Prevalence (AUS adults) Attributable Burden Key Guideline Source
Tobacco smoking (daily) 8.3% (2022–23 ABS) ~7.0% of total DALYs RACGP Supporting smoking cessation (2024)
Inadequate fruit & vegetable intake ~90% (fewer than 5 serves veg/day) ~5.4% of total DALYs AGHE 2013; NHMRC Dietary Guidelines
Harmful alcohol use 1 in 4 exceed lifetime risk guidelines ~4.5% of total DALYs NHMRC Alcohol Guidelines (2020)
Physical inactivity ~75% insufficient activity ~5.3% of total DALYs Australian Physical Activity Guidelines (2021)
Overweight & obesity 67% of adults (ABS 2022–23) ~8.4% of total DALYs National Obesity Strategy 2022–2032
⚠️
Key gap: Despite evidence of benefit, only 30–40% of Australian adults report receiving preventive care advice from their GP in the past 12 months (ABS National Health Survey). Systematic approaches β€” using the SNAP, 5As, and NEAT frameworks β€” close this gap and align practice with RACGP Standards.

Health Promotion in General Practice

Health promotion in general practice operates across three levels, consistent with the Ottawa Charter for Health Promotion (WHO 1986) and adapted to the Australian primary care context:

1
Primary Prevention
Preventing disease onset through vaccination, lifestyle counselling, and risk-factor modification in healthy individuals. Example: counselling a 35-year-old with a family history of T2DM on weight management and physical activity.
2
Secondary Prevention
Early detection and intervention in asymptomatic or pre-symptomatic disease. Example: cervical screening (National Cervical Screening Program), cardiovascular risk assessment (Australian CV Risk Calculator), and type 2 diabetes screening (AUSDRISK tool).
3
Tertiary Prevention
Reducing complications and improving quality of life in established chronic disease. Example: GP Management Plans (MBS 721), annual cycle-of-care for diabetes, and cardiac rehabilitation referrals.

MBS Health Assessment Items

MBS Item Description Eligible Population Frequency
701 Brief health check All ages Once per 12 months
703 Standard health assessment 45–49 years at risk of chronic disease Once per 12 months
705 Prolonged health assessment 75+ years (annual health assessment) Once per 12 months
707 Health assessment β€” permanent residents of aged care facilities All ages in residential aged care Once per 12 months
715 Aboriginal and Torres Strait Islander health check All Aboriginal and Torres Strait Islander peoples Once per 9 months

Opportunistic vs Structured Approaches

  • Opportunistic: Brief advice delivered during any consultation, even when the presenting complaint is unrelated. Evidence supports 30-second to 3-minute "teachable moments" for smoking cessation and alcohol reduction.
  • Structured: Dedicated preventive health consultations (e.g., 45–49-year health check, 75+ health assessment, antenatal booking visit) using standardised templates and recall systems.
  • Population-based: Practice-level recall and reminder systems, clinical audit (e.g., PEN Clinical Audit Tool, CAT4), and quality-improvement activities aligned with the Practice Incentives Program (PIP) Quality Improvement measures.

The SNAP / 5As / NEAT Guide

SNAP Framework

The SNAP framework was developed by the RACGP and the Australian Government Department of Health to provide a systematic approach to identifying and managing the four leading modifiable behavioural risk factors in general practice. SNAP stands for:

S
Smoking
Cigarette smoking, e-cigarette/vaping use, and other tobacco products. Ask about status at every visit; use the FagerstrΓΆm Test for dependence severity.
Screen: every visit | Intervene: 5As model
N
Nutrition
Dietary intake assessment using short dietary questions, fruit/vegetable serves, discretionary food intake, and sugar-sweetened beverages. Refer to dietitian if complex needs.
Screen: annual health check | Tools: AGHE, short dietary questionnaire
A
Alcohol
Screen with AUDIT-C (3 questions) or full AUDIT (10 questions). NHMRC guidelines recommend ≀10 standard drinks/week and ≀4 on any single occasion to reduce lifetime risk.
Screen: annually or if risk identified | Intervene: brief intervention, referral to AOD services
P
Physical Activity
Adults should accumulate 150–300 min moderate or 75–150 min vigorous activity per week, plus resistance training β‰₯2 days/week. Screen with the Active Australia Survey.
Screen: every visit | Refer: exercise physiologist, Green Prescription

The 5As Model

The 5As model is the gold-standard brief intervention framework for any behavioural risk factor in primary care. It can be delivered in as little as 3–5 minutes during a routine consultation.

1
Ask
Systematically screen for SNAP risk factors. Use validated tools (AUDIT-C, AUSDRISK, Active Australia Survey). "Do you smoke?" "How many serves of vegetables do you eat daily?"
2
Assess
Evaluate readiness to change using the Stages of Change model (Prochaska & DiClemente). Assess severity, current knowledge, and barriers. Perform relevant examinations (BMI, waist circumference, BP).
3
Advise
Provide clear, non-judgemental, personalised advice linking the behaviour to health outcomes. Use motivational interviewing techniques. "Based on your intake, drinking 6 standard drinks most evenings increases your liver cancer risk significantly."
4
Assist
Provide practical support: self-help materials, quit kits, referrals (Quitline 13 7848, dietitian, exercise physiologist, psychologist, AOD counsellor), pharmacotherapy (NRT, varenicline), goal setting, and written action plans.
5
Arrange
Schedule follow-up. Use recall/reminder systems. Document in GP Management Plan (MBS 721). Review progress at next visit. 70% of relapses occur within 8 weeks β€” early follow-up is critical.

NEAT Desktop Guide

The NEAT (Nutrition, Exercise, Alcohol, Tobacco) guide is a quick-reference tool for GPs designed to integrate preventive health screening into every consultation. It summarises key screening questions, brief advice scripts, and referral pathways in a single-page format suitable for the consulting room wall or clinical software desktop.

N β€” Nutrition
"How many serves of fruit and vegetables do you eat most days?"
Target: β‰₯2 fruit + β‰₯5 veg serves/day
Refer dietitian if BMI β‰₯30 or chronic disease
E β€” Exercise
"How many days a week do you do at least 30 minutes of activity?"
Target: β‰₯5 days Γ— 30 min (moderate)
Refer exercise physiologist if sedentary + chronic disease
A β€” Alcohol
AUDIT-C: "How often do you have a drink?" + "How many on a typical day?" + "How often β‰₯6 drinks?"
Target: ≀10 standard drinks/week, ≀4/session
Brief intervention if AUDIT β‰₯5; refer AOD if AUDIT β‰₯20
T β€” Tobacco
"Do you smoke or use tobacco/vaping products?"
Target: complete cessation
NRT (PBS), varenicline (PBS Authority), Quitline 13 7848
βœ…
Practice tip: Embedding SNAP screening questions into clinical software (e.g., Best Practice, Medical Director) as mandatory fields during annual health checks ensures systematic documentation and audit capability.

Nutrition for Health

Nutrition is one of the most impactful modifiable risk factors for chronic disease in Australia. Poor diet is estimated to contribute to approximately 5.4% of the total burden of disease and is a major driver of obesity, type 2 diabetes, cardiovascular disease, and certain cancers. GPs play a critical role in nutritional assessment, brief counselling, and referral to accredited practising dietitians (APDs).

Australian Guide to Healthy Eating (AGHE) β€” Key Recommendations

Food Group Adult Servings/Day (19–50 yr) Standard Serve Example
Vegetables & legumes 5–6 Β½ cup cooked veg; 1 cup salad; Β½ medium potato
Fruit 2 1 medium apple/banana; 2 small apricots; 1 cup canned fruit (no added sugar)
Grains & cereals 4–6 (mostly wholegrain) 1 slice bread; Β½ cup cooked rice/pasta; β…” cup wheat cereal
Lean meat, poultry, fish, eggs, legumes 2.5–3 (men) / 2 (women) 65 g cooked meat; 80 g cooked fish; 2 eggs; 1 cup cooked legumes
Dairy & alternatives 2.5–3 250 mL milk; 200 g yoghurt; 40 g cheese

Practical GP Nutrition Counselling Strategies

  • Use the short dietary questionnaire (2 questions on fruit and vegetable intake) as a rapid screen during consultations.
  • Set SMART goals: "Aim to add one extra serve of vegetables to your dinner three times this week" rather than broad advice like "eat healthier".
  • Use motivational interviewing β€” explore ambivalence, elicit change talk, and support self-efficacy.
  • Provide written resources: Nutrition Australia fact sheets, Get Healthy Information and Coaching Service (1800 806 258, free NSW program).
  • Refer to an Accredited Practising Dietitian (APD) for patients with: BMI β‰₯30, chronic kidney disease, type 2 diabetes, eating disorders, food insecurity, or culturally specific dietary needs.
  • Dietitian referrals are rebatable under MBS Items 10950–10952 (group allied health) and under Chronic Disease Management plans (MBS 721/723, up to 5 allied health sessions per calendar year).

Key Nutritional Targets for Chronic Disease Prevention

Nutrient / Factor Target Relevance
Sodium <2,000 mg/day (5 g salt) Hypertension, CVD β€” NHF recommendation
Saturated fat <10% of total energy LDL-C reduction, CVD prevention
Added sugars <6 tsp/day (25 g) Obesity, T2DM, dental caries
Dietary fibre β‰₯25 g (women) / β‰₯30 g (men) Colorectal cancer prevention, glycaemic control
Alcohol ≀10 standard drinks/week Cancer, liver disease β€” NHMRC 2020
Sugar-sweetened beverages Nil / avoid Obesity, T2DM, dental erosion
ℹ️
Food insecurity: Approximately 1 in 6 Australian adults experience food insecurity (ABS 2022–23). GPs should screen vulnerable populations (those on low incomes, single parents, Aboriginal and Torres Strait Islander peoples, recent migrants) and refer to community food programs (e.g., OzHarvest, SecondBite, local food banks).

Psychosocial Health Promotion

Psychosocial determinants β€” including mental health, social connectedness, financial stress, domestic and family violence, and cultural safety β€” are fundamental drivers of overall health outcomes. The general practice setting offers a unique opportunity for early identification, brief intervention, and referral for psychosocial concerns.

Mental Health Screening Tools in General Practice

Tool Target Condition Threshold for Action Notes
PHQ-9 Major depression β‰₯10 = moderate; β‰₯20 = severe Validated in Australian primary care; free to use
K10 Psychological distress β‰₯22 = high; β‰₯30 = very high Used in ABS National Health Survey; culturally sensitive
GAD-7 Generalised anxiety β‰₯10 = moderate anxiety Comorbid with depression β€” screen both
DAST-10 Drug use disorders β‰₯3 = moderate; β‰₯6 = substantial/severe Pair with AUDIT for comprehensive substance use screen
EPDS Perinatal depression β‰₯13 = possible depression Antenatal and postnatal; RACGP recommends at 6 weeks, 6 months, 12 months
RUCS / HEEADSSS Adolescent psychosocial assessment Domain-specific concerns Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety

Domestic and Family Violence (DFV)

🚨
Mandatory consideration: In several Australian states and territories, GPs have mandatory reporting obligations for child abuse and neglect. While adult DFV reporting is not uniformly mandatory, the RACGP recommends that all GPs are trained in DFV screening and response. Use the I-ASk (Identification and Screening to Ask about violence) framework. Refer to 1800RESPECT (1800 737 732) for specialist counselling and safety planning.

Social Isolation and Loneliness

  • Social isolation increases all-cause mortality by approximately 30% (comparable to smoking 15 cigarettes/day; Holt-Lunstad et al. 2015).
  • Screen older adults (β‰₯65 years) using the De Jong Gierveld Loneliness Scale or the Three-Item Loneliness Scale.
  • Refer to community programs: Men's Sheds, community gardens, volunteer programs, My Aged Care (1800 200 422) for Commonwealth Home Support Programme services.
  • Social prescribing β€” GPs linking patients to non-clinical community services β€” is an emerging model being piloted across several PHNs.

Mental Health Treatment Plans (MBS Item 2710/2712)

  • MBS Item 2710: GP Mental Health Treatment Plan β€” allows referral to psychological services (up to 10 individual + 10 group sessions per calendar year under Medicare).
  • MBS Item 2712: Review of GP Mental Health Treatment Plan.
  • Services can be provided by clinical psychologists (MBS 80010), psychologists (MBS 80000), or allied mental health professionals including social workers and occupational therapists.
  • No diagnosis is required to initiate a Mental Health Treatment Plan β€” the plan is based on clinical assessment and patient need.

Special Populations

πŸ‘Ά

Paediatrics

Childhood obesity affects approximately 1 in 4 Australian children (2–17 years). Early intervention in general practice is critical.
Use age- and sex-specific BMI percentile charts (WHO growth charts) for children <5 years and extended BMI charts for children β‰₯5 years.
The Infant Feeding Guidelines (NHMRC 2012) recommend exclusive breastfeeding to 6 months, then introduction of solids with continued breastfeeding to 12 months and beyond.
Adolescent health checks using the HEEADSSS framework should address vaping/e-cigarettes, social media use, screen time, and mental health.
National Immunisation Program (NIP) schedule provides free vaccines β€” ensure catch-up schedules are current for all paediatric patients.
🀰

Pregnancy & Perinatal

Antenatal care provides a concentrated opportunity for health promotion: smoking cessation, alcohol abstinence, nutrition, physical activity, and mental health screening (EPDS at booking, 28 weeks, and postnatally).
Folic acid supplementation (500 Β΅g daily) recommended for β‰₯1 month pre-conception and through first trimester.
Iodine supplementation (150 Β΅g daily) recommended during pregnancy and breastfeeding.
Gestational diabetes screening via OGTT at 24–28 weeks (or earlier if high risk).
Referral to perinatal mental health services if EPDS β‰₯13 or clinical concern.
πŸ‘΄

Older Adults (β‰₯65 years)

Annual 75+ health assessment (MBS 705) should include comprehensive SNAP screening, falls risk assessment, medication review, cognitive screening (GP-COG or MMSE), and advance care planning discussion.
Frailty screening using the Clinical Frailty Scale or FRAIL questionnaire guides resource allocation and care planning.
Nutrition screening with the Mini Nutritional Assessment Short Form (MNA-SF) identifies malnutrition risk β€” refer to dietitian and consider oral nutritional supplements if MNA-SF ≀7.
Encourage resistance-based exercise for falls prevention (β‰₯2 sessions/week, evidence-based programs such as Stepping On).
🫘

Chronic Kidney Disease

Nutritional management of CKD requires specialist dietitian input: protein restriction (0.6–0.8 g/kg/day in CKD 3–4), potassium management, sodium restriction (<2,000 mg/day), and phosphate restriction.
Physical activity is safe and beneficial in CKD β€” aim for 150 min/week moderate activity (Kidney Health Australia).
Refer to renal dietitian via nephrology outpatients or private APD with CKD experience.
🫁

Hepatic Impairment

Alcohol-related liver disease: brief interventions in primary care reduce harmful drinking by 20–30%. Use AUDIT-C screening and the 5As model.
Patients with cirrhosis require individualised nutrition guidance β€” avoidance of overnight fasting (>3 hours), adequate protein intake (1.2–1.5 g/kg/day), and small frequent meals.
Hepatitis B and C screening and treatment: all adults born in endemic countries should be screened (MBS Item 69318). Hepatitis C is curable with PBS-listed direct-acting antivirals.
πŸ›‘οΈ

Immunocompromised Patients

Patients on immunosuppressants (biologics, chemotherapy, high-dose corticosteroids) require tailored vaccination schedules β€” avoid live vaccines (e.g., MMR, varicella, yellow fever).
Annual influenza vaccination and pneumococcal vaccination (PCV13 + PPSV23) are funded under NIP for immunocompromised individuals.
Health promotion should include infection-prevention education (hand hygiene, food safety, avoidance of crowded settings during outbreaks).

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health
Life expectancy gap
Aboriginal and Torres Strait Islander Australians have a life expectancy approximately 8 years less than non-Indigenous Australians (AIHW 2023). Modifiable risk factors β€” smoking (39% vs 10%), physical inactivity, poor nutrition, and harmful alcohol use β€” contribute substantially to this gap.
MBS Item 715 Health Check
The Aboriginal and Torres Strait Islander Health Check (MBS Item 715) is available to all Indigenous Australians regardless of age, with no cap on frequency (available once per 9 months). It provides a structured framework for SNAP screening, chronic disease risk assessment, immunisation review, and culturally safe health promotion. Uptake remains below target (~30% of eligible population) β€” practices should implement proactive recall systems.
Cultural safety
Health promotion must be delivered in a culturally safe, strengths-based, and trauma-informed manner. Avoid deficit-based language. Recognise the impact of intergenerational trauma, Stolen Generations, and ongoing systemic racism on health behaviours and engagement. Use Aboriginal Community Controlled Health Organisations (ACCHOs) for collaborative care.
Remote and rural access
Approximately 35% of Aboriginal and Torres Strait Islander peoples live in remote or very remote areas. Telehealth (MBS Items 91790, 91800, 91801, 91802) enables specialist and allied health consultations. Patient Assisted Travel Schemes (PATS) in each state/territory assist with transport to appointments.
Smoking in pregnancy
Aboriginal and Torres Strait Islander women smoke during pregnancy at approximately 4 times the rate of non-Indigenous women. Targeted programs (e.g., Deadly Choices, Quitline Indigenous services) and culturally appropriate resources are essential. Nicotine replacement therapy is safe in pregnancy and should be offered alongside behavioural support.
Social and emotional wellbeing (SEWB)
The SEWB framework recognises that mental health for Aboriginal and Torres Strait Islander peoples encompasses connection to body, mind/emotions, family/kinship, community, culture, Country, and spirituality. Use the SEWB framework rather than purely Western diagnostic models when assessing psychosocial needs. Refer to Aboriginal and Torres Strait Islander mental health services and social and emotional wellbeing teams.
ACCHO partnerships
Partnering with local Aboriginal Community Controlled Health Organisations (ACCHOs) enhances culturally safe care delivery, supports community health worker-led programs, and improves health check completion rates. The National Aboriginal Community Controlled Health Organisation (NACCHO) provides resources and a directory of ACCHOs nationally.
⚠️
Close the Gap: The National Agreement on Closing the Gap (2020) includes health promotion targets related to smoking, healthy birthweight, suicide prevention, and chronic disease. Every GP practice has a role in contributing to these targets through systematic, culturally safe preventive care delivery.

πŸ“š References

  1. 1. Royal Australian College of General Practitioners (RACGP). Guidelines for Preventive Activities in General Practice (Red Book), 9th edition. Melbourne: RACGP; 2016 (updated 2023).
  2. 2. Royal Australian College of General Practitioners (RACGP). Smoking Cessation β€” Supporting Smoking Cessation: A Guide for Health Professionals. Melbourne: RACGP; 2024.
  3. 3. Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease Study: Impact and Causes of Illness and Death in Australia 2024. Canberra: AIHW; 2024.
  4. 4. National Health and Medical Research Council (NHMRC). Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra: NHMRC; 2020.
  5. 5. National Health and Medical Research Council (NHMRC). Eat for Health: Australian Dietary Guidelines. Canberra: NHMRC; 2013.
  6. 6. Department of Health and Aged Care, Australian Government. National Obesity Strategy 2022–2032. Canberra: Commonwealth of Australia; 2022.
  7. 7. Department of Health and Aged Care, Australian Government. Australian Physical Activity and Sedentary Behaviour Guidelines for Adults (18–64 years). Canberra: Commonwealth of Australia; 2021.
  8. 8. Harris MF, Bailey L, Snowdon T, et al. Developing the guidelines for preventive activities in general practice (the Red Book). Aust Fam Physician. 2016;45(12):876–879.
  9. 9. Royal Australian College of General Practitioners (RACGP). Standards for General Practices, 5th edition. Melbourne: RACGP; 2020 (updated 2023).
  10. 10. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227–237.
  11. 11. National Aboriginal Community Controlled Health Organisation (NACCHO). National Guide to a Preventive Health Assessment for Aboriginal and Torres Strait Islander People, 3rd edition. Melbourne: RACGP/NACCHO; 2018.
  12. 12. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary Report 2023. Canberra: AIHW; 2023.
  13. 13. Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22(4):267–284.
  14. 14. Government of Australia. Closing the Gap National Agreement. Canberra: Commonwealth of Australia; 2020.
for PBS-listed medicines at participating pharmacies.
Cultural safety
Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.
Medication adherence
Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.
Specific conditions
Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.
Referral pathways
Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

πŸ“š References

  1. 1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
  2. 2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
  3. 3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
  4. 4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
  5. 5. Smolen JS, LandewΓ© RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
  6. 6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
  7. 7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
  8. 8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
  9. 9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
  10. 10. Pisetsky DS. Antinuclear antibody testing β€” misunderstood or misused? Clin Immunol. 2023;255:109717.
  11. 11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
  12. 12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFΞ± blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
  13. 13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).
for PBS-listed medicines at participating pharmacies.
Cultural safety
Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.
Medication adherence
Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.
Specific conditions
Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.
Referral pathways
Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

πŸ“š References

  1. 1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
  2. 2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
  3. 3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
  4. 4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
  5. 5. Smolen JS, LandewΓ© RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
  6. 6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
  7. 7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
  8. 8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
  9. 9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
  10. 10. Pisetsky DS. Antinuclear antibody testing β€” misunderstood or misused? Clin Immunol. 2023;255:109717.
  11. 11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
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