This Resource kit was produced by a joint project between North East Valley Division of General Practice, Melbourne Division of General Practice, Northern Division of General Practice and the North East Health Promotion Centre.

Members of the GP Visitors Program:
Dr Shane Conway	GP: Northern Division of General Practice
Dr Jack Deady	GP: Northern Division of General Practice
Dr Jane Froster	GP: North East Valley Division of General Practice
Ms Darlene Henning	Project Coordinator/Practice Facilitator
Dr David Oberklaid	GP: Melbourne Division of General Practice
Dr Tarquin Oehr	GP: Melbourne Division of General Practice
Dr Andrew Pattison	GP: North East Valley Division of General Practice
Dr Matthew Pattison	GP: North East Valley Division of General Practice
Dr Denise Ruth	GP: Melbourne Division of General Practice
Dr Zoltan Vilagosh	GP: Melbourne Division of General Practice
Members of the Men's Health Promotion in General Practice Reference Group:
Mr Slade Carter	Program Officer: Northern Division of General Practice
Dr Jack Deady	GP: Northern Division of General Practice
Ms Fiona Duffey	Program Coordinator: North East Valley Division of General Practice
Mr Mark Griffiths	Consumer
Mr Rick Hayes	Men's Health Consultant: North East Health Promotion Centre
Ms Darlene Henning	Project Coordinator
Ms Kellie Ann Jolly	Director: North East Health Promotion Centre
Dr John Litt	GP Health Promotion Consultant: RACGP
Mr Phil Morley	Consumer
Dr David Oberklaid	GP: Melbourne Division of General Practice
Dr Andrew Pattison	GP: North East Valley Division of General Practice
Ms Bev Peterson	Practice Manager representative
Ms Lara Watson	Program Officer: Melbourne Division of General Practice
Ms Elizabeth Wheeler	Program Coordinator: North East Valley Division of General Practice

A complete reference list is included on page 17, however special thanks to the main contributors of this resource:

• Dr Andrew Pattison's The M Factor: Men and their health. Simon & Schumaster: Australia

• Central Bayside Division of General Practice Men's health resource kit

• North West Melbourne Division of General Practice Addressing the health needs of low socio-economic males: A resource for general practitioners, practices and divisions of general practices

• Strathmore Clinic for their Health Promotion Record Card

• The Royal Australian College of General Practitioners Periodic Health Consultation Form.

• Drs Jane Froster and Denise Ruth for Tips on engaging men regarding preventive health

• Dr David Oberklaid for What to include in male health checks, by age

• The Sydney Morning Herald for the Shakespeare cartoon on the cover

©2001 North East Valley Division of General Practice

This resource has been made possible by an Innovations Pool grant from the Commonwealth Department of Health and Aged Care

 

GP Visitation Program 2000-2001……….............................. 4

Introduction ………..............................................................5

Men's Health Risks at a Glance ….......................…..........…6

Changeable Risk Factors.....................................…..........…7

Tips on how to Engage Male Patients .....….........…...........…8

What to include in Male Health Checks, by age ......…..........10

Patient Education ………....................................................12

Community Support ...........................................................14

References .......................................................................17

Appendix A……………………….......Men's Health Check Flyer

Appendix B……………………….......Men's Health Questionnaire

 

As part of the 1998-99 Divisions of General Practice Innovations Pool program, the Department of Health and Aged Care funded a two-year collaborative project between North East Valley, Northern and Melbourne Divisions of General Practice and North East Health Promotion Centre. The aim of the project is to assist General Practices, as a whole and general practitioners (GPs) individually, to practice health promotion, especially with male patients.

The two main programs developed to do this are the Practice Support Program and the GP Visitors Program. The Practice Support Program aims to assist with the development and organisation of structures and systems at the practice level to enable and enhance prevention. (These include assisting with the development of a practice Health Promotion Plan, systems for organising recalls and reminders, etc.).

The GP Visitors Program aims to provide GPs with an opportunity to discuss with a like-minded colleague, possibilities for promoting the health of male patients within the consulting room. This Resource kit has been produced as part of this program for later reference and use by GPs.

The resource kit provides up to date information and statistics on men's health. It also identifies behavioural differences (risk factors) between the sexes that may be influencing health outcomes for men. The kit provides suggestions on how GPs might engage male patients more effectively and lists areas requiring attention in a consult with males at different ages. Lastly, information is provided on patient education and using referrals to community support organisations. Should more information be required, references have been included.

Why Men's Health?
Men have a different approach to their health and to doctors then women. Men have a higher risk of preventable death and some health problems that are specific to their sex.

Why should GPs practice health promotion?
GPs already practice health promotion as a routine part of patient care. However, there is scope for improving the frequency and efficacy of health promotion messages by applying structured and systematic approaches.

Some GPs doubt their effectiveness in providing health promotion advice. However, there is evidence that:

• GPs' health promotion messages are effective.

• Research has shown the efficacy of simple consultation-based approaches by GPs.

• There are many opportunities for prevention in general practice.

• Up to 85% of the population visit a GP at some stage each year.

• Patients view the GP as a key, first contact and credible source of preventive advice.
  
  
  

Source: RACGP. (1998). Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting. Melbourne.

General

• Average life expectancy for men is 75 years; for women it is 81 years.

• Male deaths are greater at all ages, and the discrepancy begins from infancy.

Young Adults (15-24 years)

• Males are nearly three times as likely to die as females.

• Males are three times more likely to die from motor vehicle accidents.

• Males are four times more likely to suicide.

Adults (25-64 years)

• Males are twice as likely to die as females.

• Males are four times more likely to die from cardiovascular disease.

• Males are twice as likely to develop NIDDM.

• Males are four times more likely to suicide.

• Males are three times more likely to die in a motor vehicle accident and four times as likely to die in other accidents.

• Males are at least three times more likely to die from alcoholic liver disease.

Source: Pattison, A. (1998). The 'M' Factor: Men and their health. Simon and Schuster: Australia.
Department of Human Services Victoria (1999) Victorian Burden of Disease Study: Mortality
Department of Human Services Victoria (1999) Victorian Burden of Disease Study: Morbidity

Consider the following table…

Table 1 shows deaths by age, sex and cause for Victorians in 1996.
Source: Department of Human Services Victoria (1999) Victorian Burden of Disease Study: Mortality

Changeable Risk factors

• Men are more likely to eat foods high in fat.

• Men tend to exercise less (after age 35).

• Men are more likely to drink alcohol in excessive amounts.

• Men are more likely to smoke.

• Men are more likely to use illicit drugs.

• Risk-taking behaviour can mistakenly be believed to demonstrate masculinity.

• Men are less likely to admit to experiencing emotional stress.

• Men are less likely to visit a GP without being prompted.

• Men are less likely to seek preventive assistance.

• Men are often effective when they decide to change their risk behaviours.

Source: Alexander, G. (1992/93) Dilemmas of care, XY Men, Sex, Politics, 2(4), 21-22. Department of Health and Aged Care; (1998) Men's health: A research agenda and background report

One of the biggest barriers to GPs promoting men's health is that men don't visit their GP very often. When they do, it's usually with acute medical problems, and often too late for prevention.

GPs can encourage men to use their GP as a resource for health, not merely as a source of diagnosis and treatment. This shift can only happen with the development of trusting relationships between men and their GPs. Here are some tips to build trust and thereby promote men's access to General Practice. By using these simple measures, you should be able to get men in the door, help them to talk about their health, support them in behaviour change and return to you for further health care.

Getting men to come in:

	Show that the practice has an interest in men's health, through displaying men's health posters and information.
	Ask female patients about their partner's/son's health.
	Provide female patients with a leaflet on "Men's Health" to give to their partners (see Appendix A for an example).
	Consider having a library of books/videos about men's health that can be borrowed.

Getting men to open up and talk during the consultation:

	Provide a questionnaire for men to complete prior to entering the consulting room that will prompt discussion on health promotion issues (see Appendix B for two examples).
	Establish rapport and build a relationship to understand the whole person.
	Initiate discussion - eg. How would you rate/describe your own health? Do you have any health or personal concerns troubling you?
	Be specific in your questions about sensitive issues if appropriate.
	Explain medical terms.
	Encourage men to book for longer consultations to address health concerns.
	Reassure men that consultations are confidential.
	Avoid being judgemental.

Helping men to make changes to promote their health:

	Explain the relationship between health, behaviour and social environment.
	Try to relate the need for behavioural changes to current presenting problem, eg. URTI/chest infection - smoking, stress at work.
	Assess health risks with the patient.
	Find common ground with the patient to reduce risk and promote health, eg. what changes to make first.
	Work with the patient to assess his barriers to change.
	Help him to gain increased sense of control over his health.
	Gain a commitment for change.
	Note risk status and management plan in medical record.
	Encourage regular follow-up.
	Refer males to relevant community networks/support groups.

Getting men to come back:

	Explain the importance of an overall health check and what is involved.
	After explaining the importance of a health check strongly encourage men to make an appointment before leaving the practice that day.
	Give take-home reminders, eg. Urine jar, handout/leaflet, pathology form.
	Explain how to ask for a longer consultation.

When they do come back:

	Follow up the patient to monitor and support changes in health behaviours and risks.
	Be pro-active in praise and follow up of issues previously raised/discussed.
	Re-emphasise the importance of continued regular care (annual check-ups)

see also 1 page pdf from Current therapeutics article 

It is important to encourage males at all ages to be conscious of their health and how they can maintain and improve it. To engender a culture where males are at ease with prevention and to assist in the early detection of preventable diseases, assess all your male patients under the following categories. It may be necessary to arrange additional appointments to ensure enough time is available. As many men rarely attend a doctor it is worth encouraging them to have a health check annually.

YOUNG BOYS (0-9 YEARS)
Check General health and development. Weight and height. Developmental progress (speech, learning, motor skills) Immunisation record. Undescended testes or groin hernias.	Discuss Social development: self-esteem. Family relationships School Skin protection from UV light.
OLDER BOYS (10-19 YEARS)
Check General health and development Weight and height Blood pressure Mental health. Self esteem. Is there any evidence of depression?  Stress? Immunisation. Is a tetanus booster required?	Discuss Diet and exercise. Skin care. Family relationships. School. Skin protection from UV light. Smoking, alcohol and drugs. Driving safety. Accidents and risk taking. Testicular self-exam. Sexual health.
YOUNG ADULTS (20-49 YEARS)
Check Blood pressure. Blood cholesterol level about every 5 years. Urine test for diabetes Family history of conditions such as melanoma, bowel cancer, prostate cancer, hyperlipidemia, diabetes. Are any specific tests required? Skin. Is there any sign of UV damage or skin cancer? Mental health. Is there any evidence of depression? Stress? Immunisation. Is a tetanus booster required? Hepatitis B? MMR?	Discuss Diet and exercise. Particular attention to abdominal obesity. Smoking, alcohol and drugs. Relationships. Parenting. Occupational health and safety. Employment. Accidents and risk taking. Driving safety. Testicular self-exam. Sexual health.
OLDER ADULTS (50-74 YEARS)
Check All the items for younger adults Prostate disease. Annual rectal exams. PSA blood tests when indicated. Diabetes. Urine tests. Blood if required. Glaucoma eye check if required. Skin. Is there any evidence of skin cancer?	Discuss Diet and exercise Smoking and alcohol Family Retirement
ELDERLY MEN (75+ YEARS)
Check Full Health Assessment Blood pressure Arthritis Memory loss. May need glaucoma eye check. Urinary stream. Very elderly men do not require regular rectal examinations unless they are worried by urinary symptoms. Skin: signs of skin cancer/melanomas. Mental health: any evidence of depression?	Discuss Diet/nutrition and exercise Carer relationships Social connectedness/loneliness

Source: Pattison, A. (1998). The 'M' Factor: Men and their health. Simon and Schuster: Australia.
The information on this page will be updated in 2001, when the RACGP Preventive Care Guidelines are released.

Providing resources for your patients is another way of practicing Health Promotion. It is important to provide opportunities for patients to select information of interest to them (in the waiting room), however a patient is much more likely to feel the information is important and directly personal if it is handed out by the GP within the consultation.

Below is a list of some of the available resources that specifically relate to men. You may want to arrange to have a supply handy in your room or be familiar with where they are located in the practice.  View concise index in pdf

Some of the information in the table below is on our website .. visit our A - Z index

Resource Table

Source: Central Bayside Division of General Practice Men’s health resource kit

In providing health care for your patients that fully promotes their health and well being it will be appropriate, at times, to refer to other organisations. This may be because you do not have time for extended counselling sessions or perhaps others can offer more expertise in a certain area. There are many community networks/ organisations and support groups that would be appropriate for you to refer your male patients to. Sometimes your patients may also need you to encourage them to seek the services of schools, unions, the clergy or legal assistance.

The best way to access up to date information on local services is by using the Infoxchange Service Seeker database available on the internet. The website

www.infoxchange.net.au/db

is a great resource for all types of referrals and extremely easy to use. Here are the contact numbers for a selected few services that you may find useful.

Aids
Peter Knight Centre: 9865 6700
Victorian AIDS Council/Gay Men's Health Centre: 9525 4455

Arthritis
Arthritis Foundation: 1800 640 862

Asthma
Asthma Foundation: 1800 645 130

Cancer
AntiCancer Council of Victoria: 9635 5000
Cancer Helpline/Information Services: 13 11 20

Crisis
Lifeline: 13 11 14
Crisis line: 24-hour telephone counselling: 9329 0300

Diet/Nutition
Australian Nutrition Foundation: (02) 9552 3081
Gutbusters: 1800 674 688
National Heart Foundation: 1300 362 787
Diabetes Australia: 1800 640 862

Domestic abuse/child protection
Men's Referral Service: 9428 2899 or 1800 065 973
Preston Creative Living Centre: 9471 0108
North East Centre Against Sexual Assault: 9496 5770
Victim's Referral and Assistance Centre: 9603 9797 or 1800 819 817

Exercise
Life Activities Club: 9670 4417
Parks Victoria: 13 19 63
Bicycle Victoria: 1800 639 634

Mental Health
Lifeline: 13 11 14
Crisis line: 24-hour telephone counselling: 9329 0300
Mental Health Foundation of Australia: 9427 0407
National Mental Health Strategy: 1800 066 247

Occupational Health and Safety
The WorkCover Advisory Service: 9641 1444 or 1800 136 089

Relationships
Relationships Australia: 1-800-817-569
Do Care - Northern Region: 9435 1168
Lifeworks Relationship Counselling and Educational Services: 9654 7360
Men's Counselling Services: 9489 1010

Sexual Health/Family Planning
Melbourne Sexual Health Centre: 9347 0244 or 1800 032 017
Sexual Health and Family Planning Clinic: 9489 1388
Family Planning Victoria: 9257 0100

Smoking and addictions
Quit: 13 18 48
Alcoholics Anonymous: 9429 1833
Turning Point Alcohol and Drug Centre: 9254 8061

Anderson, P. (1993). Management of alcohol problems: the role of the general practitioner. Alcohol & Alcoholism, 28(3), 263-272.

Charlton, B. G., Calvert, N., White, M., Rye, G. P., Conrad, W. & Zwanenberg, T van. (1994). Health promotion priorities for general practice: constructing and using indicative prevalences. BMJ, 308, 1019-1022.

Connell, R. W., Schofield, T., Walker, L., Wood, J., Butland, D. L., Fisher, J. & Bowyer, J. (1998). Men's health: a research agenda and background report. Commonwealth Department of Health and Aged Care. Sydney.

Cupples, M. E. & McKnight, A. (1994). Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk. BMJ, 309, 993-996.

Gerald Shaper, A., Goya Wannamethee, S. & Walker, M. (1997). Body weight: implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men. BMJ, 314, 1311.

Hippisley-Cox, J., Fielding, K. & Pringle, M. (1998). Depression as a risk factor for ischaemic heart disease in men: population based case-control study. BMJ, 316, 1714-1719.

House of Representatives Standing Committee on Family and Community Affairs (1997). Men's health: Summary report of a seminar, Parliament House, Canberra, 26th September.

Pattison, A. (1998). The 'M' Factor: Men and their health. Simon and Schuster: Australia.

Richmond, R. & Heather, N. (1990). General practitioner interventions for smoking cessation: past results and future prospects. Behaviour Change, 7(3), 110-119.

Royal Australian College of General Practitioners (1996) Guidelines for preventive activities in general practice (4th edition). Melbourne

Royal Australian College of General Practitioners (1998) Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting. Melbourne

Wilson, A. & McDonald, P. (1994). Comparison of patient questionnaire, medical record, and audio tape in assessment of health promotion in general practice consultations. BMJ, 309, 1483-1485.

(1999). The Victorian burden of disease study: Mortality. Department of Human Services, Melbourne.

(1999). Men's health promotion: Strategic framework. North East Health Promotion Centre & VicHealth, Melbourne

(2000). Moving forward in men's health: Better health good health care. New South Wales Health Department. Sydney.

Men's Health Questionnaire

Here are two examples of questionnaires you may like to use to assist in prompting discussion on health issues with your male patients.

Decide which one you feel more comfortable with.

• The first can be downloaded from this site and customised with your practice's letterhead or contact details. 
  View layout     Download Questionnaire in html, doc & pdf format

• The second is available from the Royal Australian College of General Practitioners. http://www.racgp.org.au  ... see also practice survey 

	Arrange for Reception staff to hand the Questionnaire to men when they present for an appointment. It is important to make sure that patients have not recently completed the form. You may wish to ask your Receptionist to give the form to men with a comment along the lines of "If you haven't completed one of these Questionnaires in the last six months, or if something has changed in the way that you look after your health, you might like to fill this in before you see the doctor. Just give it to him/her when you go in."
	You can use the patient's responses to guide your discussion on Health Promotion issues during the consultation
	Don't assume that because a male patient has not completed the form, he does not have risk factors or health promotion issues which he would like to discuss.
	You may wish to retain the patient's completed questionnaire in the medical record.
	You may also wish to enter some or all of the data on the patient's electronic record.
	Patients who complete the Questionnaire on more than one occasion (eg. every 6-12 months) may be interested to see changes in their risk factors over time

Your doctor would like to be able to help you maintain and improve your health. Please complete the following questionnaire and present it to your doctor.

1. Please tick your current main interests.

Family

Relationships

Paid Work

Study Work

Unpaid Work

Personal well being

Sport and recreation activites ............................................................................................................

Hobbies and leisure activities .............................................................................................................

2. Please tick the good things about how 'fit and well' you are.

Have lots of energy

Sleep well

Always eat breakfast

Good cholesterol level

No 'pot belly'

Active (3 x wk/ 30mins)

3. Are you concerned about the influence of the following factors on your health?

Smoking

Drinking

Loneliness

Eating habits

Weight

Work environment

Lack of Exercise

Stress

Family problems

4. Do you smoke?

Yes >> please go to Q. 4a

No

Q4a. Do you wish to quit?

ex smoker

Yes No

Undecided

5. How often do you engage in exercise or activity (eg., brisk walking long enough to work up a light sweat (at least 30 minutes)?

3 or more times a week

seldom

1-2 times per week

never

7. Have you been getting sufficient sleep lately?

Yes

No

Don't know

8. Have you ever had a cholesterol test?

Yes

No            Don't know      Date: ……………

9. Have you had a tetanus injection in the past 10 years?

Yes

No            Don't know      Date: ……………

Name:___________________________________ Date:______________________