The 45–49-year health check
Many routine preventative activities dropped off during the COVID-19 pandemic. The 45-49 health check is a useful tool to assess our patient’s health and risk factors and provide a preventative management plan with them for the future. It’s worth noting that this health check can take place at any age for Aboriginal or Torres Strait Islander people.
You can use the Medicare Health Assessments (items 701, 703, 705, 707 and 715) to provide a one-off 45–49-year heath check — or item 715 for an Aboriginal or Torres Strait Islander person.
This assessment is for patients “at risk of developing chronic disease”. The decision rests on a clinical judgement made by the GP. Factors to consider include, but are not limited to:
- lifestyle risks, such as smoking, physical inactivity, poor nutrition or alcohol use
- biomedical risks, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight
- a family history of a chronic disease.
What’s included in the 45–49-year health assessment?
The RACGP’s Guidelines for preventive activities in general practice (Red Book) suggests a number of areas that should be covered for preventive health in persons aged 45 to 49. Their checklist (.pdf) suggests:
- History: smoking, nutrition, alcohol and physical activity, possible depression, osteoporosis risk factors.
- Examination: weight, height, BMI, BP, skin.
- Tests: lipids, fasting BSL/HBA1c%, cervical screen (if appropriate).
- risk of diabetes using the Australian type 2 diabetes risk assessment tool
- review fracture risk factors for osteoporosis for women aged 45-years or older
- absolute cardiovascular risk.
- Plan: work with your patient to make a plan to manage their risk factors.
Preventive health activities at the 45-49 health check
Cardiovascular risk assessment tool
Assessment of absolute CVD risk using multiple factors is an evidence-based approach that is more accurate than treating individual risk factors alone, because it acknowledges cumulative effects.
Creating even a moderate reduction in several risk factors is more effective in reducing overall CVD risk than a major reduction in a single one alone, as the Heart Foundation explains in its Heart Health Check Toolkit.
The risk is calculated as a traffic light of low risk (green), medium risk (orange) or high risk (red). The CVD risk factors are assessed are:
- smoking status
- diabetes status
- systolic blood pressure
- total cholesterol and HDL cholesterol levels
Here is an interactive tool to perform CVD risk assessments. cvdcheck.org.au
AUSDRISK – The Australian Type 2 Diabetes Risk Assessment Tool
The AUSDRISK online tool is an interactive evidence-based tool that assesses the risk of a person developing type 2 diabetes over the next 5 years. It assigns risk as low, moderate, high or very high. It assesses known risk factors including:
- family history
- previous episodes of elevated blood sugar eg during pregnancy
- presence of additional risks such as hypertension and smoking
- physical exercise
- waist measurement
FRAX Fracture Risk Assessment Tool for assessing osteoporosis
The FRAX Fracture Risk Assessment Tool is an interactive online tool that calculates a patient’s 10-year fracture risk. It can be used with and without a bone mineral density result. While it can be set to Australia, the advantage of using the UK setting is that it includes clinical guidance, also in a traffic light format. It takes in to account major risk factors for osteoporosis including:
- age and gender
- previous fracture history
- family history of a fractured hip
- smoking status and alcohol consumption
- glucocorticoid use
- history of rheumatoid arthritis
- history of secondary osteoporosis
The Life! program is a free healthy lifestyle program. It is jointly funded the Victorian Government and managed by Diabetes Victoria. There are group courses or a telephone health coaching service for people who are at risk of developing type 2 diabetes and cardiovascular disease. You could refer to the Life! program those who you find to be at higher risk of type 2 diabetes and cardiovascular disease that you identify during the health check. Research shows that patients are more likely to attend a program such as this if recommended by their trusted health practitioner.
Practical considerations and tips for 45–49-year health checks
- Agree on a template. Most software comes pre-loaded with one. The team should agree on the components of the check. Are there things you want to add?
- Make it easy for staff to access the risk calculators. If they are not integrated in your practice software, make sure they are in your library.
- Do you have a team member who can identify eligible patients and recall them using your clinical software or PEN Clinical Audit Tool?
- Who will you invite? Will you invite all 49-year-olds and repeat every year? Or 45-year-olds? Depending on how busy you are you could invite all 45 to 49-year-olds initially to catch up, then, annually, choose an age to invite. The risk in inviting 49-year-olds is that by the time they act on the invite they may no longer be eligible. It might be more practical to invite 45- or 48-year-olds.
- Do you use a recall/reminder system (such as an SMS service) to invite patients to book for an assessment?
- Host an education session for staff. Make sure all practitioners are familiar with the 45–49-year template and with using the clinical tools. How will you structure the assessment? You may consider having them see a practice nurse first, then a GP.
- Establish rules for booking these assessments and ensure staff know them.
- Can you get the practice nurse to arrange pre-testing prior to the appointment, so that blood results are available on the day?
Tips for billing
- How will you bill this? It might be more inviting for the patient if it is bulk-billed as a free health assessment.
- Ensure all practitioners are aware of the health assessment items and the claiming rules.
- If someone is no longer eligible for the health assessment item by the time they present they may be eligible for a 699 Heart Health Assessment.
Risk Assessment, Recall and Referral Project – a quality improvement project for general practice
North Western Melbourne Primary Health Network is recruiting general practices and Aboriginal Community Controlled Health Organisations (ACCHO) to improve early detection and prevention of cardiovascular disease and diabetes.
Funding of $3,500, excluding GST, is available for each participating practice.
Expressions of interest will close at 3pm on Tuesday 14 March 2023.
Visit this link for more information and to apply.
- CVD risk assessment online calculator
- Heart Foundation Heart Health Toolkit
- Diabetes risk assessment tool
- FRAX fracture risk assessment tool
- RACGP checklist for 45–49-year health assessment (.pdf)
HealthPathways Melbourne is the best way for GPs to quickly access all the information they need for the following assessments:
- 45 to 49-year-old Health Check
- Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715)
- Absolute Cardiovascular Disease Risk Assessment
- Health Assessments