What is the history of the Green Prescription program in New Zealand primary care?

History of the Green Prescription Program in New Zealand Primary Care

The Green Prescription (GRx) program in New Zealand was developed as a primary care physical activity scripting program to help increase population levels of physical activity among insufficiently active adult New Zealanders. 1

Origins and Development

The Green Prescription emerged as a response to the recognition that many New Zealanders were insufficiently active, despite the known benefits of regular physical activity for both prevention and management of chronic health conditions 1. The program was designed as part of New Zealand's primary healthcare strategies, which began placing higher priority on increasing physical activity among the population 2.

The program represents a formalized system where:

• General practitioners (GPs) can "prescribe" physical activity to patients
• Patients receive ongoing support to maintain their physical activity levels
• The prescription serves as both a preventive and management tool for various health conditions

Implementation and Structure

The Green Prescription program was structured to provide:

1. Initial GP consultation and prescription of physical activity
2. Ongoing telephone counseling support
3. Print materials to guide patients
4. Later modifications included pedometer-based versions for older adults 3

By 2001-2002, the program was established enough to be the subject of retrospective surveys examining its effectiveness 4. This suggests the program had been implemented at least several years prior to this period.

Evolution of the Program

Over time, the Green Prescription program evolved to address specific population needs:

• By 2012, research was examining barriers specific to older adults receiving Green Prescriptions 5
• By 2020, modifications to the standard program included pedometer-based Green Prescriptions specifically designed for older adults 3

This evolution demonstrates how the program adapted over time to better serve different demographic groups and address identified barriers to participation.

Professional Considerations

It's worth noting that the implementation of the Green Prescription program was not without controversy. Physical Educators raised concerns about the strategies employed, suggesting that a system of referral to accredited exercise professionals might be more effective for changing physical activity behaviors 2. This highlights the professional tensions that sometimes accompanied the program's development.

Key Benefits Identified

Throughout its history, the Green Prescription has been valued by healthcare providers for:

• Offering a non-medication approach to a healthier lifestyle
• Providing support benefits for physical activity
• Serving both primary prevention (e.g., weight control) and secondary management (e.g., diabetes management) purposes 1
• Potentially benefiting mental health conditions like depression 1

Implementation Challenges

The historical development of the program also reveals persistent challenges:

• Time constraints within GP consultations were identified as a barrier to program implementation 1
• For older adults specifically, barriers included chronic health conditions, fear of injury, transportation constraints, set routines, and lack of confidence 5

These challenges led to recommendations for delegating time-consuming tasks to patient support counselors and involving practice nurses in Green Prescription administration 1.