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Health Minister Jonathan Coleman says the health benefits of Green Prescriptions continue to be demonstrated, as more and more people take medical advice to get fit and eat well to help tackle their health problems.

“The Green Prescriptions initiative is going from strength to strength. Three quarters of patients who were issued with a Green Prescription in 2014 said they had experienced positive health changes as a result,” says Dr Coleman.

Patients with type 2 diabetes or pre-diabetes, or those who are overweight or with health problems such as high blood pressure can get a Green Prescription from their GP or practice nurse.

These prescriptions contain advice on nutrition and physical activity to help manage their condition and reduce the risk of developing complications. Local initiatives range from cooking classes to motivational texts and boot camps.

In the last three months of 2014 more than 11,000 Green Prescriptions were issued, up from 9,272 in the same period last year.

This year close to 50,000 referrals are expected for people to receive support to get more active and eat healthier food.

“Obesity and diabetes are some of our greatest health challenges,” says Dr Coleman.

“We are working in partnership with regional sports trusts, primary health organisations and agencies like Diabetes NZ to make sure that people get the support they need to lead a healthier life and enjoy it too.”

Further information about Green Prescriptions can be found on the Ministry of Health website, www.health.govt.nz.

‘It was a real surprise’ recalls Brian....

when first diagnosed with type 2 Diabetes almost ten years ago. ‘There hadn’t been any family history of Diabetes that we know of.’

 Since his diagnosis, Brian now 72, has been managing his Diabetes by moderating his diet and having regular 3 monthly check-ups with the Diabetes nurse.

Brian’s says the biggest on-going challenge is his ‘healthy appetite’. Over time, Brian has learnt which foods he can eat in moderation and those best to avoid. Nectarines and Chocolate are out, but Brian still likes to enjoy a cool beer on a hot Summer’s day, even if it’s a low alcohol, low sugar brand!

A few years ago, Brian’s GP suggested the Green Prescription Programme as a way to maintain weight and increase activity. Joining the local gym with an individual programme has increased Brian’s mobility and fitness. ‘I must admit, I really enjoy the sociability of it as well. I go to the gym once a week and, as often as I can, I go to the pool as well, I’m really pleased with the results, and I feel better.’ Brian also takes part many of the in Green Prescription Programme co-ordinated activities such as group walks.

While managing his Diabetes well, Brian has had to learn to manage his condition without relying the use of a Glucose meter, which has been a challenge. Along with the regular Diabetes nurse appointment, Brian also sees a Diabetes specialist once a year as part of a regular maintenance programme.

 Brian’s advice to people new to Diabetes is to ‘look after yourself, eat well and exercise, but don’t give up on all of life’s pleasures!’

“These are people who have agreed to receive support to be more physically active, not people who have just been advised to get more exercise,” says the Ministry of Health’s Manager for Green Prescriptions, Diana O’Neill.

Support can take the form of:

• monthly telephone calls for three to four months
• face-to-face meetings for three to four months or
• group support in a community setting for three to six months.

The patient’s progress is reported back to the referring health professional and if the patient feels they would benefit from ongoing support, they are encouraged to ask their health professional for another Green Prescription.

Ms O’Neill has been involved with the Green Prescription initiative since it was first established by the former Hillary Commission for Recreation and Sport.

It started off as a bit of a wacky idea and some doctors thought it was a bit patronising and wouldn’t last the distance. But when primary health organisations (PHOs) were set up and given dedicated health promotion funding, Green Prescriptions started being taken more seriously.

"Now awareness of Green Prescriptions among GPs and practice nurses is very high. They see it as part of normal practice and it’s really becoming embedded in primary health care."

Within the Ministry of Health, the Green Prescription strategy is also aligned with those for long-term conditions and chronic disease, such as diabetes, cancer and cardiovascular disease, the health of older people and Better, Sooner, More Convenient health care.

“This brings numerous benefits, from funding to making the most of programme links across the Ministry and out to primary health,” she says.

Recent research, published in the British Journal of General Practice, found Green Prescriptions in New Zealand are also cost-effective, especially where direct supervision or instruction was not required.

The study found that walking, exercise groups, or brief exercise advice on prescription delivered in person or by phone or mail, appeared to be more cost-effective than supervised gym-based exercise classes or instructor-led walking programmes. It also found that many physical activity interventions were as cost effective as funded pharmaceutical interventions.

Ms O’Neill says all Green Prescriptions are based on verbal plus written advice because clinical trials by the Heart Foundation in the early days of the initiative showed this was the most effective approach.

She says there’s been a move to more face-to-face or group support over the last few years because phone-based support doesn’t suit some population groups.

“Some people don’t like being phoned by a ‘stranger’, and certain population groups, such as Māori, Pacific and older people, often prefer the social contact of a group activity, which then becomes another form of support.

“But others are happy just to have a regular phone call, so it’s about providing options.”

More recently, the Green Prescriptions Active Families programme has been established to meet the needs of inactive children and young people who are at risk of adverse health effects from being overweight or obese.

The community-based health initiatives are designed to increase physical activity in children and young people aged 5 to 18 and their whanau/families, with priority given to children aged 5 to 12 years.

Each programme provides support for a minimum of 35 children and young people and their families for a period of up to 12 months.

More than 600 children and their families are expected to participate in the Active Families programme this year.

This article appeared in the HIIRC Update, June 2011

Related articles from that issue:

Warfarin pilot signals new partnerships in health care

Ministry booklet outlines 'Better, Sooner, More Convenient' primary health care

Prescribing nurses an exciting innovation

Delivering 'Better, Sooner, More Convenient' primary health care

The aim of this systematic review was to assess the cost-effectiveness of physical activity interventions in primary care and the community. Thirteen studies fulfilled the reviews inclusion criteria, including New Zealands' green prescription programme study. The overall results of the review were that most interventions to increase physical activity were cost-effective, especially where direct supervision or instruction was not required. Walking, exercise groups, or brief exercise advice on prescription delivered in person, or by phone or mail appeared to be more cost-effective than supervised gym-based exercise classes or instructor-led walking programmes.

Garrett, S., et al. (2011). Are physical activity interventions in primary care and the community cost-effective? British Journal of General Practice, 61 (584), e125-e133

For information on how to access the full text of this article, go to: http://www.ingentaconnect.com/content/rcgp/bjgp/2011/00000061/00000584/art00005 or contact your local or organisational library for assistance.