Sustainable chronic disease management in remote Australia

SNAP is a model for the general practice management of four common behavioural risk factors: smoking, nutrition, alcohol and physical activity. The SNAP program was developed for the Australian Government in 2002. In 2003 and 2004, a feasibility study was conducted in one urban and one rural division of general practice (DGP) in NSW, in partnership with their local area health services. Information technology support and referral directories were developed, based on an initial needs assessment, SNAP guidelines, a clinical summary chart, patient education materials, and general practitioner and staff training. GPs reported that the SNAP approach fitted general practice consultations well. After its implementation, they were more confident in using motivational interviewing and SNAP interventions and referred more frequently. The impact and sustainability of the SNAP program were limited by a lack of effective practice teamwork, poor linkages with referral services, and the lack of a business model to support SNAP in the practices. DGPs could play an important role in providing practice visits and resources to improve communication, education and collaboration to support SNAP programs.We are grateful to the Australian Primary Health Care Research Institute (APHRI) for funding this study, as well as facilitating an innovative process for interaction between different research groups. The Sharing Health Care Initiative and its evaluation was funded by the Australian Government Department of Health and Ageing. We acknowledge the original evaluation work carried out by the Cooperative Research Centre for Aboriginal Health, Menzies School of Health Research and PricewaterhouseCoopers. We are particularly grateful to the Katherine West Health Board for its support. Alison Stewart conducted interviews and Kerry Barber generously assisted at the drafting stage. We thank the staff of APHCRI, particularly Bev Sibthorpe, and the other research groups for their constructive comments