The Victorian Active Script Programme: promising signs for general practitioners, population health, and the promotion of physical activity

Abstract

Background: The Active Script Programme (ASP) aimed to increase the number of general practitioners (GPs) in Victoria, Australia who deliver appropriate, consistent, and effective advice on physical activity to patients. To maximise GP participation, a capacity building strategy within Divisions of General Practice (DGPs) was used. The objectives of the programme were to (a) train and support GPs in advising sedentary patients, and (b) develop tools and resources to assist GPs. Objective: To evaluate the effectiveness of the ASP. Methods: A systems approach was used to promote capacity in Victorian general practice. Economic analyses were incorporated into the programme's evaluation. Participants were selected DGPs and their GP members. The programme worked with DGPs to train GPs and provide relevant resources. The main outcome measures were (a) changes in GP knowledge and behaviour and (b) cost effectiveness, based on modelled estimates of numbers of patients advised and adopting physical activity and gaining the associated health benefits. Results: GP awareness and provision of physical activity advice increased. Although the programme's reach was modest, based on actual GP involvement, the cost effectiveness figures ($138 per patient to become sufficiently active to gain health benefits, and $3647 per disability adjusted life year saved) are persuasive. Conclusions: The ASP increased DGPs' capacity to support GPs to promote physical activity. There is a strong economic argument for governments to invest in such programmes. However, caution is warranted about the maintenance of patients' activity levels. Programme refinement to encourage GPs to use community supports more effectively will guide future development. Further research on long term patient adherence through a multisectorial approach is warranted.

Are brief interventions to increase physical activity cost-effective? A systematic review

“…Thirteen met the inclusion criteria and were included in the review (figure 1). Five studies originated from the UK (one of them in Scotland),35–39 four from New Zealand,40–43 two from Australia,44 45 and one each from Sweden46 and the Netherlands 47…”

“…38 Seven studies performed economic modelling using data from a single trial,40 44 46 a meta-analysis of RCTs,37 44 47 a systematic review of randomised and observation studies,35 or a cross-sectional and observational study 45. Four studies reported intermediate outcomes in terms of the cost of making one additional inactive person active;36 39 41 42 five reported final outcomes in terms of incremental cost per DALY44 or QALY40 47 or LYG46 or incremental net health benefit (NHB)37 and four reported both intermediate and cost-utility outcomes 35…”

“…Four studies reported intermediate outcomes in terms of the cost of making one additional inactive person active;36 39 41 42 five reported final outcomes in terms of incremental cost per DALY44 or QALY40 47 or LYG46 or incremental net health benefit (NHB)37 and four reported both intermediate and cost-utility outcomes 3538 43 45…”

“…In pedometer-based interventions, a common threshold measure used was ≥10 000 steps/day except for one study39 which used a target of a weekly increase of ≥15 000 steps. Six studies36 39–42 45 reported the duration of brief interventions (face-to-face), which lasted from 4 to 30 min. Most (10) of the included studies evaluated each intervention in comparison with usual care or current practice, which approximates a ‘do nothing’ scenario.…”

Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence

“…Interventions within general practices had the most favourable cost-effectiveness ratios (€106 per participant to reach at least 3300 kJ expended per week); however, the study was based on modelled rather than actual costs. 34 Gordon et al reviewed the cost-effectiveness of a number of lifestyle interventions for smoking cessation, physical activity, diet, and alcohol reduction. 35 The findings for physical activity interventions generally indicated favourable costeffectiveness: less than €55 860 per QALY, and two studies showed net cost savings.…”