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Kulmala J, Rosenberg A, Ngandu T, Hemiö K, Tenkula T, Hyytiä A, Vienola M, Huhtamäki-Kuoppala M, Saarinen A, Korkki S, Laatikainen T, Solomon A, Kivipelto M. Facilitators and barriers to implementing lifestyle intervention programme to prevent cognitive decline. Eur J Public Health 2021; 31:816-822. [PMID: 34448856 PMCID: PMC8505000 DOI: 10.1093/eurpub/ckab087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Finnish Intervention Study to Prevent Cognitive Impairment and Disability is a randomized controlled trial that has tested the efficacy of a multidomain intervention targeting modifiable risk factors to prevent cognitive impairment/dementia. A combination of healthy diet, physical, social and cognitive activity, and management of cardiovascular risks was shown to be an effective model to promote brain health among older people. The aim of this qualitative study was to explore healthcare professionals' perceptions of facilitators and barriers to implementing this lifestyle programme into health care. METHODS Four semi-structured focus group interviews were conducted among healthcare professionals working in primary care and in non-governmental organizations (N=27). Participants were asked to discuss their perceptions of facilitators and barriers for implementing the multidomain intervention into clinical practice. Interviews were analyzed using content analysis. RESULTS Barriers and facilitators described by the healthcare professionals were related to infrastructure and resources, client's personal characteristics and the lifestyle intervention itself. These main categories included several sub-categories related to knowledge, motivation, resources, individualization and collaboration. The interviewees pointed out that more education on dementia prevention is needed, the work should be coordinated efficiently, resources to provide preventive health care should be adequate and multiprofessional collaboration is needed. CONCLUSIONS Transferring a lifestyle intervention from a trial-setting to real life requires knowledge about the factors that influence effective implementation. Identifying drivers and constraints of successful implementation helps to design and tailor future prevention programmes, increases motivation and adherence and supports system change.
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Affiliation(s)
- Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland.,Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rosenberg
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Katri Hemiö
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tarja Tenkula
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | - Arja Hyytiä
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | | | | | | | - Saana Korkki
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Alina Solomon
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Miia Kivipelto
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
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Zwiep T, Ahn SH, Brehaut J, Balaa F, McIsaac DI, Rich S, Wallace T, Moloo H. Group practice impacts on patients, physicians and healthcare systems: a scoping review. BMJ Open 2021; 11:e041579. [PMID: 33419910 PMCID: PMC7798803 DOI: 10.1136/bmjopen-2020-041579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To identify the advantages and disadvantages that group practices have on patients, physicians and healthcare systems. STUDY DESIGN A scoping review was performed based on the methodology proposed by Arksey and O'Malley, and refined by Levac et al. Titles and abstracts were screened by two reviewers. A quantitative analysis was performed to assess the type, year and region of publication, as well as the population studied. A qualitative descriptive analysis was performed to identify common themes. STUDY SETTING MEDLINE, EMBASE and Cochrane databases were searched from database inception to October 2018 for papers which assessed outcomes relevant to the research question. RESULTS Our search strategy returned 2408 papers and 98 were included in the final analysis. Most papers were from the USA, were surveys and assessed physician outcomes. Advantages of group practices for patients included improved satisfaction and quality of care. Studies of physicians reported improved quality of life and income, while disadvantages included increased stress due to poor interpersonal relationships. Studies of healthcare systems reported improved efficiency and better utilisation of resources. CONCLUSIONS Group practices have many benefits for patients and physicians. However, further work needs to be done assessing patient outcomes and establishing the elements that make a group practice successful.
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Affiliation(s)
- Terry Zwiep
- Surgery, Western University, London, Ontario, Canada
| | | | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fady Balaa
- Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Susan Rich
- Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tom Wallace
- Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Husein Moloo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Surgical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
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The association between GP organisational factors and the effectiveness of a prevention programme for cardiometabolic diseases: a prospective intervention study. BJGP Open 2020; 4:bjgpopen20X101111. [PMID: 33144369 PMCID: PMC7880196 DOI: 10.3399/bjgpopen20x101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022] Open
Abstract
Background Owing to the rising disease burden of cardiometabolic diseases (CMD), prevention programmes for CMD are increasingly implemented in primary care. Organisational practice characteristics and availability of preventive services may be associated with a more effective programme. Aim To identify possible organisational success factors from general practices related to an effective primary prevention programme for CMD. Design & setting A prospective intervention study involving 37 Dutch general practices was undertaken. Method Patients aged 45–70 years without known CMD, hypertension, or hypercholesterolemia were invited for the prevention programme. The outcome measures were an improvement (yes/no) in four different CMD risk factors between baseline and 1-year follow-up on an individual level (body mass index [BMI], smoking, systolic blood pressure, and cholesterol ratio). Multivariate logistic regression analysis was used for assessing associations between practice organisational characteristics and outcomes. Results Just over half of the participants showed an improvement on one or more risk factors. Marginal differences were found in the four different outcomes between the practices with different organisational characteristics. None of the practice characteristics that were tested showed a significant association with an improvement in one of the outcome measures. Conclusion In this study, general practice organisational and preventive service characteristics showed no impact on the effectiveness of a CMD prevention programme. Possible explanations could be the effectiveness of protocolised pharmaceutical treatment and only limited contribution of lifestyle programmes on the improvement of CMD risk factors.
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Gräsbeck H, Ekroos H, Halonen K, Vasankari T. Weak smoking cessation awareness in primary health care before surgery: a real-world, retrospective cohort study. Scand J Prim Health Care 2020; 38:42-46. [PMID: 32019399 PMCID: PMC7054971 DOI: 10.1080/02813432.2020.1717093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.Design: This was a retrospective cohort study.Setting: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016, involving both primary health care and specialized health care. The goals of the project were smoking awareness and preoperative smoking cessation.Subjects: Our study involved 1482 surgical patients operated at Porvoo Hospital between May and December of 2016.Main outcome measures: We studied the recording of smoking status in all patients, and ICD-10 diagnosis of nicotine dependency and the initiation of preoperative smoking cessation in current smokers. Variables were studied from electronic patient records, comparing primary health care referrals and surgical outpatient clinic records.Results: Smoking status was visible in 14.2% of primary health care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n = 275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for initiation of preoperative smoking cessation. The differences between primary health care referrals and outpatient clinic records were statistically significant for all three variables (p ≤ .001).Conclusion: In primary health care, very little attention was paid to preoperative smoking cessation. Rates were significantly better at the surgical outpatient clinic, but still low. We could not demonstrate any certain effect of the intervention. Our results call for future research on ways to improve smoking cessation rates.Key pointsTobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.We found weak smoking awareness and weak smoking cessation intervention numbers among both primary and specialized health care doctors. Our results indicate an urgent need for an efficient preoperative smoking cessation model involving both primary and specialized health care.
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Affiliation(s)
- Helene Gräsbeck
- Department of Pulmonary Medicine, Porvoo Hospital, Porvoo, Finland;
- Doctoral Programme of Clinical Research, University of Helsinki, Helsinki, Finland;
- CONTACT Helene Gräsbeck Department of Pulmonary Medicine, Porvoo Hospital, Sairaalantie 1, 06150 Porvoo, Finland
| | - Heikki Ekroos
- Department of Pulmonary Medicine, Porvoo Hospital, Porvoo, Finland;
| | - Kimmo Halonen
- Department of Surgery, Porvoo Hospital, Porvoo, Finland;
| | - Tuula Vasankari
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland;
- Finnish Lung Health Association (FILHA), Helsinki, Finland
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Stol DM, Badenbroek IF, Hollander M, Nielen MMJ, Kraaijenhagen RA, Schellevis FG, de Wit NJ. Effectiveness of a stepwise cardiometabolic disease prevention program: Results of a randomized controlled trial in primary care. Prev Med 2020; 132:105984. [PMID: 31954837 DOI: 10.1016/j.ypmed.2020.105984] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
Effective preventive strategies for cardiometabolic disease (CMD) are needed. We aim to establish the effectiveness of a stepwise CMD risk assessment followed by individualized treatment if indicated compared to care as usual. We conducted a RCT between 2014 and 2017. Individuals (45-70 years) without CMD or CMD risk factors were invited for stepwise CMD risk assessment through a risk score (step1), additional risk assessment at the practice in case of high-risk (step2) and individualized follow-up treatment if indicated (step3). We compared newly detected CMD and newly prescribed drugs during one-year follow-up, and change in CMD risk profile between baseline and one-year follow-up among participants who completed step2 to matched controls. A CMD was diagnosed almost three times more often (OR 2.90, 95% CI 2.25: 3.72) in the intervention compared to the control group, in parallel with newly prescribed antihypertensive and lipid lowering drugs (OR 2.85, 95% CI 1.96: 4.15 and 3.23, 95% CI 2.03: 5.14 respectively). Waist circumference significantly decreased between the intervention compared to the control group (mean -3.08 cm, 95% CI -3.73: -2.43). No differences were observed for changes in BMI and smoking. Systolic blood pressure (mean -2.26 mmHg, 95% CI -4.01: -0.51) and cholesterol ratio (mean -0.11, 95% CI -0.19: -0.02) significantly decreased within intervention participants between baseline and one-year follow-up. In conclusion, implementation of the CMD prevention program resulted in the detection of two- to threefold more patients with CMD. A significant drop in systolic blood pressure and cholesterol levels was found after one year of treatment. Modelling of these results should confirm the effect on long term endpoints. Trial registration: Dutch trial Register number NTR4277.
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Affiliation(s)
- Daphne M Stol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
| | - Ilse F Badenbroek
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Mark M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
| | - Roderik A Kraaijenhagen
- Netherlands Institute for Prevention and E-health Development (NIPED), Amsterdam, the Netherlands.
| | - François G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands; Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands.
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Ahnfeldt-Mollerup P, Riisgaard H, Søndergaard J, Nexøe J. Cross-cultural adaptation of the medical engagement scale into Danish general practice setting. Scand J Prim Health Care 2019; 37:200-206. [PMID: 31057019 PMCID: PMC6566796 DOI: 10.1080/02813432.2019.1608042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: The need to involve doctors in healthcare leadership has long been recognized by clinical staff and policymakers. A Medical Engagement Scale has been designed in England to evaluate levels of medical engagement in leadership and management. Objective: The aim of this study was to translate and adapt the scale and to test the translated version for comprehension and suitability in Danish general practice setting. Design and method: The process involved forward translation, backward translation, and field tests. The field tests included cognitive debriefing interviews. In all 30 general practitioners and 5 non-general practitioners participated in the process of translation. After using the scale among 1652 general practitioners statistical analysis was carried out to test internal consistency. Setting: The study was carried out in general practice in Denmark. Results: Several changes made during the process in order to achieve a Danish version that is acceptable, understandable and still capable of measuring medical engagement comparable of the original English version. Analysis of scale internal consistency using Cronbach's alpha revealed acceptable reliability for all three meta-scales, which ranged from 0.69 to 0.81. The overall tool achieved a Cronbach's alpha of 0.89. Conclusion: The Danish version of the Medical Engagement Scale is a valid and reliable tool that is acceptable and relevant for general practice in Denmark. Key points This study describes the cross-cultural adaptation of the Medical Engagement Scale from a UK primary healthcare setting to a Danish primary healthcare setting. The process produced a relevant and acceptable questionnaire measuring medical engagement. Internal consistency revealed acceptable reliability The translation of the scale provides the possibility to use this scale for practical and academic purposes.
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Affiliation(s)
- Peder Ahnfeldt-Mollerup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Helle Riisgaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jørgen Nexøe
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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