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Brandt SK, Essig S, Balthasar A. Professional beliefs of physicians and allied health professionals and their willingness to promote health in primary care: a cross-sectional survey. BMC PRIMARY CARE 2024; 25:188. [PMID: 38802787 PMCID: PMC11129482 DOI: 10.1186/s12875-024-02412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Primary care professionals could play a key role in health promotion implementation. A fundamental aspect that might affect the willingness of primary care professionals to strengthen health promotion, and about which we do not yet know much, are professional beliefs. Therefore, we conducted a quantitative survey to (1) compare professional beliefs and the willingness to work more in health promotion between five major primary care professions, and (2) investigate associations between professional beliefs and the willingness to work more in health promotion. METHODS A large-scale cross-sectional study based on a nation-wide web-based survey of primary care professionals in Switzerland was conducted from January to July 2022. The survey was addressed to pharmacists, physicians, medical practice assistants, nurses, and physiotherapists working in primary care in Switzerland. Differences between groups were tested using T-tests and Chi-square tests. Multivariable logistic regression analyses were used to evaluate the association between variables related to professional beliefs and the willingness to work more in health promotion. RESULTS The responses of 4'063 primary care professionals were used for analysis. Most primary care professionals revealed a salutogenetic attitude towards their primary care tasks. Members of all professions showed high awareness of their tasks in tackling increased risks of disease (80.2% of all participants). Especially allied health professionals wished to see a greater role of prevention in primary care (pharmacists: 72.4%, medical practice assistants: 63.9%, nurses: 75.6%, physiotherapists: 73.9% versus physicians: 46.9%). All professional groups showed a high willingness to work more in health promotion (88% of all participants). Salutogenetic beliefs of primary care professionals and their willingness to work more in health promotion are strongly associated. Participants agreeing that health promotion should play a greater role or that preventive consultations should be offered in primary care, are more willing to work more in health promotion compared to participants who disagree with these ideas. CONCLUSIONS Both affiliation to allied primary care professions and salutogenetic professional beliefs are associated with higher willingness to work more in health promotion. The high willingness provides evidence of a large, yet untapped potential. Promoting salutogenetic beliefs might further increase the willingness to engage in health promotion.
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Affiliation(s)
| | - Stefan Essig
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Interface Policy Studies Research Consulting, Lucerne, Switzerland
| | - Andreas Balthasar
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Schroeder T, Haug M, Georgiou A, Seaman K, Gewald H. Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study. JMIR Mhealth Uhealth 2024; 12:e48345. [PMID: 38231550 PMCID: PMC10831587 DOI: 10.2196/48345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/30/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The enactment of the "Act to Improve Healthcare Provision through Digitalisation and Innovation " (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany's medical landscape. OBJECTIVE This study aims to investigate physicians' responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps. METHODS Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021. RESULTS The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians' self-perceived digital competence and their evaluation of patients' digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps. CONCLUSIONS Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians' and patients' sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice.
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Affiliation(s)
- Tanja Schroeder
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Institute for Digital Innovation, Faculty of Information Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Maximilian Haug
- Institute for Digital Innovation, Faculty of Information Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Heiko Gewald
- Institute for Digital Innovation, Faculty of Information Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
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Mosteiro Miguéns DG, Rodríguez Fernández A, Zapata Cachafeiro M, Vieito Pérez N, Represas Carrera FJ, Novío Mallón S. Community Activities in Primary Care: A Literature Review. J Prim Care Community Health 2024; 15:21501319231223362. [PMID: 38197384 PMCID: PMC10785739 DOI: 10.1177/21501319231223362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024] Open
Abstract
Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.
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Affiliation(s)
| | - Almudena Rodríguez Fernández
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maruxa Zapata Cachafeiro
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Natalia Vieito Pérez
- University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Bordbar N, Shojaei P, Ravangard R, Bastani P, Joulaei H, Kavosi Z. Evaluation of the World Countries Health Referral System Performance Based on World Health Organization Indicators Using Hybrid Multi-Criteria Decision-Making Model. Value Health Reg Issues 2021; 28:19-28. [PMID: 34800828 DOI: 10.1016/j.vhri.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/16/2021] [Accepted: 06/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Primary healthcare will not be effective unless there is a proper referral system. In contrast, comparing the performance of healthcare systems provides an opportunity for policy makers to determine the status of the country's healthcare system compared with their international counterparts. Therefore, we ranked the countries in terms of indicators affected by the referral system. METHODS This study was conducted in 2020. In the first phase, which was to determine the indicators affected by a country's referral system, data were collected by the Delphi method, and therefore, 13 indicators with a content validity ratio equal to or greater than 0.42 were selected. In the second phase, the data of 13 indicators selected in the first phase were extracted from the 2018 and 2019 World Health Organization reports. The weight of the indicators was calculated based on the Decision-Making Trial and Evaluation Laboratory method-based Analytic Network Process (DANP) and Shannon's entropy, and the VIekriterijumsko KOmpromisno Rangiranje (VIKOR) method was used to rank the countries. SPSS 24 and Excel 2013 software were used for data analysis. RESULTS Switzerland, Germany, and Sweden ranked first, second, and third, respectively. In all the 3 countries, there are no mandatory gatekeeping systems. Physicians, especially general practitioners, are the core of primary healthcare, and in all the 3 countries, there is a uniform and coherent health financing system that is either based on mandatory health insurance (Switzerland and Germany) or taxes (Sweden). India had the lowest ranking. CONCLUSIONS It seems that the study of the health system of the countries that have obtained higher rankings can indicate their efforts in establishing a gatekeeping system, family physician program, and appropriate financing system. Therefore, other countries can study successful countries and copy them as a model to improve their health system.
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Affiliation(s)
- Najmeh Bordbar
- Health Services Management, Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Shojaei
- Department of Management, Faculty of Economic, management and social science, Shiraz University, Shiraz, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Calderón-Larrañaga S, Valls-Pérez B, Cardo-Miota A, Botello B, Lafuente N, Hernán M. Development and evaluation of a training programme on asset-based community development aimed at general practice trainees: protocol for a mixed-method multilevel and multicentric action research study. BMJ Open 2021; 11:e040043. [PMID: 34031107 PMCID: PMC8149302 DOI: 10.1136/bmjopen-2020-040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/09/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Asset-based community development (ABCD) is a strategy aimed at strengthening communities of interest through the identification and enhancement of those protective resources (also called 'health assets') that contribute to improve population health. Although primary care is specially well placed to contribute to ABCD by facilitating patients' access to community health assets, the implementation of ABCD approaches is limited, in part due to training deficiencies amongst general practitioners. In this study, we will develop a training programme on ABCD aimed at general practice trainees and evaluate its implementation and scale-up in Andalusia, Spain. We will also investigate whether the programme may contribute to strengthen the community orientation of the primary care practices involved in the study. METHODS AND ANALYSIS We will undertake a mixed methods, multilevel and multicentric action research study drawing on theoretical frameworks relevant to learning (pedagogy) and community health promotion. The intervention will be implemented and evaluated in eight different study areas over 48 months. It will comprise a classroom-based session and a practical exercise, which will involve general practice trainees producing a map of community health assets relevant to common health conditions. In each study area, we will set up a stakeholder group to guide our study. We will run the intervention sequentially across the eight study areas, and modify and refine it iteratively by incorporating the findings from the evaluation. We will employ qualitative (interviews and focus groups with general practice trainees, primary care workers, members of the teaching units and policymakers) and quantitative methods (self-administered questionnaires with an approximate sample of 157 general practice trainees and 502 primary care workers). ETHICS AND DISSEMINATION Ethics approval from the Andalusian Regional Health Council has been granted (6/2020). It is envisaged that this research will provide relevant, evidence-based guidance on how best to incorporate learning on ABCD into the general practice training curriculum. Findings will be disseminated in an ongoing manner and will target the following audiences: (1) general practice trainees, primary care workers and members of the teaching units, (2) policymakers and strategic decision makers and (3) the academic community.
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Affiliation(s)
- Sara Calderón-Larrañaga
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Andalusian School of Public Health, Granada, Spain
| | - Blanca Valls-Pérez
- Andalusian School of Public Health, Granada, Spain
- Andalusian Health Service, Sevilla, Spain
| | | | - Blanca Botello
- Andalusian School of Public Health, Granada, Spain
- Andalusian Health Service, Sevilla, Spain
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‘I've never given it a thought’: older men's experiences with and perceptions of ageism during interactions with physicians. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe subjective experience of ageism among older men has received little research attention. This study examines older Canadian men's experiences with and perceptions of ageism during interactions with physicians. In-depth, face-to-face interviews were conducted with 21 men aged 55 years and over. The findings indicate a seeming lack of awareness of ageism among many, and many did not believe ageism was likely to occur during patient–physician interaction. Negative stereotyping of older patients was common. A large majority of the participants reported that they had not personally experienced ageism during a medical encounter, nor were they concerned about it. Numerous rationales were proffered as explanations of why a particular participant had not experienced ageism and who was more likely to be a target.
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Broholm-Jørgensen M, Langkilde SM, Tjørnhøj-Thomsen T, Pedersen PV. 'Motivational work': a qualitative study of preventive health dialogues in general practice. BMC FAMILY PRACTICE 2020; 21:185. [PMID: 32900366 PMCID: PMC7487907 DOI: 10.1186/s12875-020-01249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/17/2020] [Indexed: 11/10/2022]
Abstract
Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.
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Affiliation(s)
- Marie Broholm-Jørgensen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| | - Siff Monrad Langkilde
- The Danish Centre for Urban Regeneration and Community Development, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Pia Vivian Pedersen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
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Akenine U, Barbera M, Beishuizen CR, Fallah Pour M, Guillemont J, Rosenberg A, Coley N, Mangialasche F, Salo L, Savy S, Pols AJ, Andrieu S, Richard E, Soininen H, Moll van Charante E, Kivipelto M. Attitudes of at-risk older adults about prevention of cardiovascular disease and dementia using eHealth: a qualitative study in a European context. BMJ Open 2020; 10:e037050. [PMID: 32764085 PMCID: PMC7412614 DOI: 10.1136/bmjopen-2020-037050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/27/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Prevention of cardiovascular disease (CVD) and dementia is a key health priority among older adults. Understanding individuals' attitudes to, the prevention of these conditions, particularly when delivered through novel eHealth tools, could help in designing effective prevention programmes. The aim of the study was to explore the attitudes of older adults at increased risk of CVD and dementia regarding engagement in eHealth self-management prevention programmes, and to describe the facilitators and barriers. DESIGN A qualitative research approach was used. Data were collected through eight focus groups in Finland, France and the Netherlands. Data were analysed following the principles of grounded theory. SETTING AND PARTICIPANTS Forty-four community-dwellers aged 65+ at risk of CVD were recruited from a previous trial cohort in Finland, and through general practices in France and the Netherlands. RESULTS The study identified three categories: access to reliable information, trust in the healthcare providers and burden and stigma of dementia. A core category was also identified: the interactive process of the three categories influencing engagement in self-management prevention programme. The categories were interconnected through an interactive process and influenced by the local healthcare culture and context which shaped them differently, becoming either facilitators or barriers to engage in eHealth self-management prevention programmes. CONCLUSIONS The study emphasises the importance of considering the interactions between the identified categories in this study, grounded in the local healthcare culture and context in further developments of eHealth self-management interventions that aim to prevent CVD and dementia. TRIAL REGISTRATION NUMBER ISRCTN48151589.
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Affiliation(s)
- Ulrika Akenine
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mariagnese Barbera
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Cathrien Rl Beishuizen
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Mandana Fallah Pour
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna Rosenberg
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Nicola Coley
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lotta Salo
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | | | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Andrieu
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Edo Richard
- Department of Neurology, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Rufener G, Cohidon C, Senn N. [Prevention of cardio-vascular disease in Swiss: general practitioners’ opinions and practices]. SANTE PUBLIQUE 2019; Vol. 31:395-404. [PMID: 31640327 DOI: 10.3917/spub.193.0395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this research is, on the one hand, to describe the customs and attitudes of Swiss general practitioners (GP) considering cardiovascular risk, and on the other, to put into perspective with the national recommendation Eviprev (summary representations of the primary and secondary preventions recommendations for patients aged between 18 and 70 years old). METHODS The study was based on an online survey sent to general practitioners belonging to the same research network and who were randomly selected. The sample was made of 200 Swiss GP. This article focuses on the frequency with which GP give advice related to consumption of tobacco and alcohol, exercising and nutrition during a regular meeting with their patient or a first visit. The results were analyzed according to age, sex, linguistic area and the extent to which they lived in a city or in the countryside. RESULTS Results suggest that the majority (97.6%) of GP show concern about informing patients on cardiovascular risk factors. Nonetheless most of the advice given are usually related to the patient’s case and not given in a systematic way. Tobacco addiction is the most systematically discussed theme during a first visit (33.9%), exercise comes second (25.6%), then nutrition (16.1%), and finally alcohol consumption (18.5%). Differences in numbers based on the different languages are little, except dealing with exercise. CONCLUSIONS Recommendations on prevention are followed by a majority of GP. Improvements could be made considering the training given and the remuneration of these counseling activities.
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Cohidon C, Wild P, Senn N. A structural equation model of the family physicians attitude towards their role in prevention: a cross-sectional study in Switzerland. Fam Pract 2019; 36:297-303. [PMID: 29945256 PMCID: PMC6531892 DOI: 10.1093/fampra/cmy063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In contrast to many studies exploring barriers to preventive care in family medicine, there is less quantitative research regarding the self-perceived role of family physicians (FPs) in prevention and its predictive factors. Moreover, the existing studies considered this attitude as a homogeneous entity. The objective of this study is firstly, to characterize FPs' attitudes towards prevention taking into account nine different prevention themes, and secondly, to explore the factors that could be predictive of this attitude. METHODS The data stem from a cross-sectional national survey on prevention we conducted in Switzerland from 2015 to 2016 (170 physicians randomly drawn, online questionnaire). We first performed a confirmatory factor analysis to define a homogeneous latent variable regarding physicians' attitude towards prevention, then, a structural equation modeling to identify potential predictors. RESULTS The FP' attitude towards their role in preventive care was homogeneously positive whatever the topic (smoking, drinking dietary habits, physical activities, and more generally, cardiovascular risk factors) except for occupational risks and cannabis consumption. A feeling of good effectiveness was a positive predictor of this positive attitude while seniority, the lack of reimbursement and being a physician from the German-speaking area were negative predictors. CONCLUSION The FP' attitude about their role in prevention is homogeneous concerning the 'classical' topics of prevention, whereas they still under-recognize certain topics as important fields for prevention. To change this situation, we probably need a global effort to introduce other ways of thinking about prevention, including not only FP but also all stakeholders.
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Affiliation(s)
- Christine Cohidon
- Institute of Family Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pascal Wild
- Institute for Work and Health, Lausanne University and Geneva University, Lausanne, Switzerland.,INRS - National Research and Safety Institute, Vandoeuvre les Nancy, France
| | - Nicolas Senn
- Institute of Family Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Tam DYS, Lo YYC, Tsui W. Knowledge, practices and expectations of preventive care: a qualitative study of patients attending government general outpatient clinics in Hong Kong. BMC FAMILY PRACTICE 2018; 19:58. [PMID: 29743033 PMCID: PMC5944064 DOI: 10.1186/s12875-018-0740-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/18/2018] [Indexed: 11/11/2022]
Abstract
Background Evidence-based preventive care recommendations have been well established, but studies have persistently reported gaps between these recommendations and general practitioners’ practices in providing preventive care. Many studies have explored factors that affect the delivery of preventive care from the perspectives of the practitioners, but relatively few have evaluated the patients’ point of view. The purpose of this study was to explore patients’ understanding of preventive care, the actions they were taking in terms of preventive health and their expectations from family doctors in providing preventive care. Methods A qualitative study was conducted based on one-on-one in-depth interviews. Twenty-eight patients without chronic illnesses were purposively recruited from government general outpatient clinics in Hong Kong. The interviews took place between November 2013 and February 2014. Results The participants’ knowledge of preventive care was limited, and their preventive practices were mostly restricted to healthy lifestyle practices. They rarely obtained individualised preventive care advice from doctors. Screening investigations were initiated after symptoms had already occurred, and the decision of what to check was arbitrary. Few of the participants knew what they wanted from their doctors in terms of preventive care. Conclusions These findings show significant gaps between evidence-based preventive recommendations and patients’ current knowledge and practice, and show the need for a wider spectrum of preventive care education and reliable sources to provide individualised and affordable preventive assessment and screening services. Most importantly, primary care providers must take a more proactive role to provide preventive services.
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Affiliation(s)
- Denise Y S Tam
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, North Wing, Room 601, 6/F, Tsan Yuk Hospital, 30 Hospital Road, Hong Kong, Hong Kong.
| | - Yvonne Y C Lo
- Wellness Family Medical Practice, Room 605, Hang Seng Tsim Sha Tsui Building, 18 Carnarvon Road, Hong Kong, Hong Kong
| | - Wendy Tsui
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, North Wing, Room 601, 6/F, Tsan Yuk Hospital, 30 Hospital Road, Hong Kong, Hong Kong
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Curbach J, Apfelbacher C, Knoll A, Herrmann S, Szagun B, Loss J. Physicians' perspectives on implementing the prevention scheme "Physical Activity on Prescription": Results of a survey in Bavaria. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 131-132:66-72. [PMID: 29486976 DOI: 10.1016/j.zefq.2018.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 12/14/2022]
Abstract
The prevention scheme called "Rezept für Bewegung" (Physical Activity on Prescription, PAP) enables physicians to formally prescribe participation in health-oriented sports programs to their patients. The PAP scheme aims to strengthen the binding character of physicians' patient counselling for physical activity. The research objective was to investigate the physicians' awareness and their use of PAP as a prevention tool in patient counselling, as well as perceived barriers to implementation. A cross-sectional total population mail questionnaire survey was performed in two districts of Bavaria. 2,821 physicians in private practice were contacted; the response rate was 32.7 %. Descriptive data analysis of 923 questionnaires was carried out using SPSS. Only 26.4 % of the respondents (244/923) were familiar with the PAP scheme, and only 7.7 % (71/923) used PAP at least once a month when counselling their patients. Key barriers to implementation include lack of information on the prevention scheme, a limited choice of local matching sports programs and an unclear commitment of health insurances to reimburse patients for participation fees. Every third physician distrusts PAP to be an efficient way of improving physical activity in patients. To foster the implementation of PAP in the future, awareness-raising campaigns and an expansion of sports programs might be helpful. In order to strengthen the physicians' confidence in the effectiveness of preventive patient counselling on physical activity, existing research evidence needs to be spread among physicians.
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Affiliation(s)
- Janina Curbach
- University of Regensburg, Department of Epidemiology and Preventive Medicine/Medical Sociology, Regensburg, Germany.
| | - Christian Apfelbacher
- University of Regensburg, Department of Epidemiology and Preventive Medicine/Medical Sociology, Regensburg, Germany
| | - Angelina Knoll
- University of Applied Science Ravensburg-Weingarten, Department for Social Work, Health and Care, Weingarten, Germany
| | - Sandra Herrmann
- Chemnitz University of Technology, Sociology with special focus on health research, Institute of Sociology, Chemnitz, Germany
| | - Bertram Szagun
- University of Applied Science Ravensburg-Weingarten, Department for Social Work, Health and Care, Weingarten, Germany
| | - Julika Loss
- University of Regensburg, Department of Epidemiology and Preventive Medicine/Medical Sociology, Regensburg, Germany
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March S, Ripoll J, Jordan Martin M, Zabaleta-Del-Olmo E, Benedé Azagra CB, Elizalde Soto L, Vidal MC, Bauzà Amengual MDL, Planas Juan T, Pérez Mariano DM, Llull Sarralde M, Ruiz-Giménez JL, Bajo Viñas R, Solano Villarubia C, Rodriguez Bajo M, Cordoba Victoria M, Badia Capdevila M, Serrano Ferrandez E, Bosom Diumenjo M, Montaner-Gomis I, Bolibar-Ribas B, Antoñanzas Lombarte A, Bregel Cotaina S, Calvo Tocado A, Olivan Blázquez B, Magallon Botaya R, Marín Palacios P, Echauri Ozcoidi M, Perez-Arauta MJ, Llobera J, Ramos M. Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case -control studies. BMJ Open 2017; 7:e015934. [PMID: 28993380 PMCID: PMC5640008 DOI: 10.1136/bmjopen-2017-015934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. DESIGN Two case-control studies. SETTING Performed in primary care of five Spanish regions. SUBJECTS In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. MAIN OUTCOME MEASURES Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. RESULTS The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). CONCLUSIONS Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.
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Affiliation(s)
- Sebastià March
- Primary Care Research Unit of Mallorca, Baleares Health Services-IB-Salut, Palma, Spain
- Balearic Islands Health Research Institute (IdISBA), Palma, Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Baleares Health Services-IB-Salut, Palma, Spain
- Balearic Islands Health Research Institute (IdISBA), Palma, Spain
| | | | | | | | - Lázaro Elizalde Soto
- Navarra Public Health Institute, Public Health and Epidemiology CIBER, Pamplona, Spain
| | - Mª Clara Vidal
- Primary Care Research Unit of Mallorca, Baleares Health Services-IB-Salut, Palma, Spain
- Balearic Islands Health Research Institute (IdISBA), Palma, Spain
| | | | - Trinidad Planas Juan
- Son Gotleu Primary Health Center, Baleares Health Services-IB-Salut, Palma de Mallorca, Spain
| | | | - Micaela Llull Sarralde
- San Agustí Primary Health Center, Baleares Health Services-IB-Salut, Palma de Mallorca, Spain
| | | | - Rosa Bajo Viñas
- Loeches Primary Health Center, Madrid Health Services, Madrid, Spain
| | | | | | | | - Marta Badia Capdevila
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Elena Serrano Ferrandez
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Maria Bosom Diumenjo
- Sant Rafael Primary Health Center, Àmbit d'Atenció Primària Barcelona-Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Isabel Montaner-Gomis
- El Carmel Primary Health Center, Àmbit d'Atenció Primària Barcelona-Ciutat, Institut Català de la Salut, Barcelona, Spain
| | | | | | | | - Ana Calvo Tocado
- Zaragoza Public Health Department, Institut Catala De La Salut, Zaragoza, Spain
| | | | | | - Pilar Marín Palacios
- Navarra Public Health Institute, Public Health and Epidemiology CIBER, Pamplona, Spain
| | | | | | - Joan Llobera
- Primary Care Research Unit of Mallorca, Baleares Health Services-IB-Salut, Palma, Spain
- Balearic Islands Health Research Institute (IdISBA), Palma, Spain
| | - Maria Ramos
- Balearic Islands Health Research Institute (IdISBA), Palma, Spain
- Public Health Department, Balearic Islands Health Department, Zaragoza, Spain
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Bucher S, Maury A, Rosso J, de Chanaud N, Bloy G, Pendola-Luchel I, Delpech R, Paquet S, Falcoff H, Ringa V, Rigal L. Time and feasibility of prevention in primary care. Fam Pract 2017; 34:49-56. [PMID: 28122923 DOI: 10.1093/fampra/cmw108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Prevention is an essential task in primary care. According to primary care physicians (PCPs),lack of time is one of the principal obstacles to its performance. OBJECTIVE To assess the feasibility of prevention in terms of time by estimating the time necessary to perform all of the preventive care recommended, separately from the PCPs and patient's perspectives, and to compare them to the amount of time available. METHODS A review of the literature identified the prevention procedures recommended in France, the duration of each procedure and its recommended frequency, as well as PCPs' consultation time. A hypothetical patient panel size of 1000 patients, representative of the French population, served as the basis for our calculations of the annual time necessary for prevention for a PCP. The prevention time from the patient's perspective was estimated from data collected from a previous study of a panel of 3556 patients. RESULTS For PCPs, the annual time necessary for all of the required preventive care was 250 hours, or 20% of their total patient time. For a patient, the annual time required for prevention during encounters with a PCP ranged from 9.7 to 26.4 minutes per year. The mean total encounter time was 75.9 minutes per year. Nearly 73% of patients had a prevention-to-care time ratio exceeding 15%. CONCLUSION Feasibility thus differs substantially between patients. These differences correspond especially to disparities in the annual care time used by each patient. Specific solutions should be developed according to the patients' utilization of care.
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Affiliation(s)
- Sophie Bucher
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, University of Paris-Sud, Le Kremlin-Bicêtre, France, .,General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Arnaud Maury
- Department of general practice, Sorbonne Paris Cité, Paris Descartes University, Paris, France and
| | - Julie Rosso
- Department of general practice, Sorbonne Paris Cité, Paris Descartes University, Paris, France and
| | - Nicolas de Chanaud
- Department of general practice, Sorbonne Paris Cité, Paris Descartes University, Paris, France and
| | - Géraldine Bloy
- LEDi, Université de Bourgogne, UMR Cnrs 6307 Inserm 1200, Dijon, France
| | - Isabelle Pendola-Luchel
- General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Raphaëlle Delpech
- General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Sylvain Paquet
- General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Hector Falcoff
- Department of general practice, Sorbonne Paris Cité, Paris Descartes University, Paris, France and
| | - Virginie Ringa
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Laurent Rigal
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, University of Paris-Sud, Le Kremlin-Bicêtre, France.,General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France
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Abstract
ABSTRACTThis study examines older women's views about and subjective experience of ageism during interactions with physicians. Views about and experience of sexism are also examined. Data were obtained from in-depth, face-to-face interviews conducted with 36 Canadian women 55 years and older. The findings indicate that older women believe ageism is likely to occur during medical encounters and are concerned about it. Few, however, claim to have personally experienced it. Contradicting the stereotype of the passive older patient, many participants were employing strategies to avoid becoming targets of ageism. Although there was some concern about sexism during medical encounters, in general, the women appeared to be less conscious of sexism than ageism.
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Craciun C. “They Do Not Know How To Use Their Health Insurance Card”: Implementation of Active Aging Policy and Aging Perceptions in Romanian General Practitioners. AGEING INTERNATIONAL 2016. [DOI: 10.1007/s12126-015-9239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rotshtein A, Karkabi K, Geyer O, Cohen Castel O. Primary care physicians' role perception and self-reported performance in glaucoma care: a survey study. BMC Res Notes 2015; 8:776. [PMID: 26653898 PMCID: PMC4677047 DOI: 10.1186/s13104-015-1770-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022] Open
Abstract
Background Glaucoma is a leading cause of blindness. The participation of primary care physicians (PCPs) in glaucoma care may improve health outcomes for glaucoma patients. Objectives To investigate PCPs’ attitudes towards their role in glaucoma care, perceived barriers, and self-reported performance in glaucoma management. Methods PCPs working in the Haifa and Western Galilee District of Clalit Health Services, Israel’s largest Health Maintenance Organization (HMO) were asked to complete a self-administered structured questionnaire. Physicians were asked to rate their agreement with statements describing the PCP’s role in glaucoma care, and to state how often they behave accordingly in their practice. In addition, physicians were asked to rate the extent that factors such as time constraints and knowledge gaps impede their performance in glaucoma care. Results Eighty-two physicians completed the questionnaire. The majority thought that PCPs have a major role in early detection of glaucoma (99 %), discussing the importance of adherence to treatment (93 %), and encouraging patients to make regular visits to their ophthalmologist (99 %). However, only 30 % reported asking patients about family history of glaucoma, 64 % reported discussing adherence to treatment, and only 35 % stated that they explain how to use eye drops, while most of respondents (87 %) regularly provide refill prescriptions for glaucoma medications. Sixty percent claimed that during their residency they had not acquired adequate knowledge and competence to allow them to take proper care of glaucoma patients. The main barriers reported were lack of time (43 %), lack of knowledge regarding treatment options and recommended follow-up (46 %), and not being familiar with glaucoma medications’ side effects (54 %). Conclusions There is a gap between PCPs’ perceptions of their role in glaucoma care and their report on actual performance in early detection and management of glaucoma. Further research is needed to develop and assess interventions that aim at closing this gap.
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Affiliation(s)
- Albina Rotshtein
- Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee, Israel. .,Division of Family Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Khaled Karkabi
- Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee, Israel. .,Division of Family Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Orna Geyer
- Department of Ophthalmology, Rappaport Faculty of Medicine, Carmel Medical Center, The Technion-Israel Institute of Technology, Haifa, Israel.
| | - Orit Cohen Castel
- Division of Family Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
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Castro PJ, Krause M, Frisancho S. Teoría del Cambio Subjetivo: Aportes desde un Estudio Cualitativo con Profesores. REVISTA COLOMBIANA DE PSICOLOGÍA 2015. [DOI: 10.15446/rcp.v24n2.44453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Se reportan los hallazgos de una investigación que reconstruye la teoría subjetiva de un grupo de docentes participantes de un diplomado de educación en valores acerca de su propio proceso de cambio. A una muestra de 12 profesores chilenos se le realizaron 35 entrevistas y se analizaron algunos documentos personales. La información se procesó mediante análisis cualitativo descriptivo y relacional, y fue codificada utilizando el programa ATLAS.ti. Los resultados indicaron que los participantes distinguen factores externos y propios como causas de sus cambios, diferencian entre vida personal y trabajo con incipientes explicaciones al integrar ambas dimensiones, y reconocen la importancia del cambio personal en el cambio profesional.</p>
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Thomas K, Krevers B, Bendtsen P. Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative. BMC Health Serv Res 2015; 15:31. [PMID: 25608734 PMCID: PMC4312445 DOI: 10.1186/s12913-015-0688-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/09/2015] [Indexed: 01/10/2023] Open
Abstract
Background Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care. Methods A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively. Results Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. Implementation: all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff. Conclusions Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.
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Affiliation(s)
- Kristin Thomas
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Barbro Krevers
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden.
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Shaikh Y, Yu F, Coleman AL. Burden of undetected and untreated glaucoma in the United States. Am J Ophthalmol 2014; 158:1121-1129.e1. [PMID: 25152501 DOI: 10.1016/j.ajo.2014.08.023] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the burden of undetected and untreated glaucoma in the noninstitutionalized population over the age of 40 years in the United States of America (US). DESIGN Cross-sectional study. METHODS setting: US civilian, noninstitutionalized population from the 2005-2006 and 2007-2008 administrations of the National Health and Nutrition Examination Survey that were 40 years old or older with completed retinal photographs, completed interview question regarding prior diagnosis of glaucoma, and a negative response to questions regarding comorbidities. main outcome measures: Prevalence of self-reported glaucoma history; signs of glaucoma damage seen in retinal photographs and perimetry; prevalence of undiagnosed glaucoma; and comparison of demographic factors using odds ratios to identify populations with highest burden of previously undiagnosed glaucoma. RESULTS The study population included 3850 participants who met the inclusion criteria. The 99.5th percentile of the vertical cup-to-disc ratio was 0.67 and the 99.5th percentile of the vertical cup-to-disc ratio asymmetry between eyes was 0.26. Prevalence of undiagnosed glaucoma was 2.9%, increasing with age to 6.6% of the population over 70 years old. Among those with glaucoma, 78% were previously undiagnosed and untreated. Blacks have roughly 4.4 times (95% confidence interval [CI]: 2.9-6.7; P < .0001) and Hispanics have roughly 2.5 times (95%CI: 1.5-4.3; P = .0012) greater odds of having undiagnosed and untreated glaucoma than non-Hispanic whites. CONCLUSIONS Approximately 2.4 million persons in the US have undetected and untreated glaucoma. Overall, prevalence of both diagnosed and undiagnosed glaucoma is much higher in minorities and the elderly. Among those with definite glaucoma, individuals younger than 60 years of age have a greater proportion of undetected disease.
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Affiliation(s)
- Yahya Shaikh
- General Preventive Medicine Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Anne L Coleman
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
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Bellón JÁ, Moreno-Peral P, Moreno-Küstner B, Motrico E, Aiarzagüena JM, Fernández A, Fernández-Alonso C, Montón-Franco C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Rüntel-Geidel A, Payo-Gordón J, Serrano-Blanco A, Oliván-Blázquez B, Araujo L, Muñoz-García MDM, King M, Nazareth I, Amezcua M. Patients' opinions about knowing their risk for depression and what to do about it. The predictD-qualitative study. PLoS One 2014; 9:e92008. [PMID: 24646951 PMCID: PMC3960156 DOI: 10.1371/journal.pone.0092008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 02/19/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based. METHODS A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socio-economic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities. RESULTS The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a "patient-centred" approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed. CONCLUSIONS Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.
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Affiliation(s)
- Juan Á. Bellón
- Centro de Salud El Palo, Departamento de Medicina Preventiva, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Unidad de Investigación del Distrito Sanitario Málaga, Málaga, Spain
| | - Patricia Moreno-Peral
- Instituto de Investigación Biomédica de Málaga, Unidad de Investigación del Distrito Sanitario Málaga, Málaga, Spain
| | - Berta Moreno-Küstner
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Málaga, Spain
| | - Emma Motrico
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Sevilla, Sevilla, Spain
| | - José M. Aiarzagüena
- Centro de Salud San Ignacio, Unidad de Investigación de Atención Primaria, Osakidetza, Bilbao, Spain
| | - Anna Fernández
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | | | - Carmen Montón-Franco
- Centro de Salud Casablanca, Instituto Aragonés de Ciencias de la Salud, Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
| | | | | | - Ariadne Rüntel-Geidel
- Departamento de Psiquiatría y Medicina legal, Universidad de Granada, Granada, Spain
| | | | | | - Bárbara Oliván-Blázquez
- Unidad de Investigación de Atención Primaria, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Luz Araujo
- Instituto de Investigación Biomédica de Málaga, Unidad de Investigación del Distrito Sanitario Málaga, Málaga, Spain
| | | | - Michael King
- Department of Mental Health Sciences, University College London, London, United Kingdom
| | - Irwin Nazareth
- Medical Research Council General Practice Research Framework, London, United Kingdom
| | - Manuel Amezcua
- Departamento de enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
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Rubio-Valera M, Pons-Vigués M, Martínez-Andrés M, Moreno-Peral P, Berenguera A, Fernández A. Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography. PLoS One 2014; 9:e89554. [PMID: 24586867 PMCID: PMC3938494 DOI: 10.1371/journal.pone.0089554] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/21/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Evidence supports the implementation of primary prevention and health promotion (PP&HP) activities but primary care (PC) professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults. METHODS AND FINDINGS A systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors) affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment) hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc.), local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP. CONCLUSIONS Research on barriers and facilitators in the implementation of PP&HP activities in multirisk management is scarce. The conceptual overview provided by this synthesis resulted in the development of practical recommendations for the design of PP&HP in PC. However, the effectiveness of these recommendations needs to be demonstrated.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
| | - Mariona Pons-Vigués
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Research Department, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Departamento de Psicología clínica y de la Salud, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María Martínez-Andrés
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | - Patricia Moreno-Peral
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Research Unit, Distrito Sanitario Malaga, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (IMABIS Foundation), Málaga, Spain
| | - Anna Berenguera
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Research Department, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Departamento de Psicología clínica y de la Salud, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ana Fernández
- Research and Development Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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What do resource-oriented approaches mean to general practitioners and how can they be facilitated in primary care? A qualitative study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:187641. [PMID: 23986779 PMCID: PMC3748733 DOI: 10.1155/2013/187641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 12/03/2022]
Abstract
Although resource orientation, as a part of health promotion, should play a major role in general practice, the anchoring and realization of resource-oriented approaches remain small in Germany. The aim of this study was to analyze what resource orientation means to general practitioners (GPs) and develop strategies as to how this can be facilitated in GP practice. Within a qualitative research approach, 19 semi-structured telephone interviews were recorded, transcribed, and analyzed using qualitative content analysis. Within the interviews, the inclusion of the patients' individual resources is described as core competence of GPs. Supporting the patients' disease coping strategies and self-help were seen as important by GPs. However, perceptions as to which resources are considered to be fundamental ranged widely across the participant group. The results confirm the important role of resource-oriented approaches in general practice. However, a general definition of resource orientation is needed. In addition, working conditions for GPs need to be taken into account to ensure that these contribute to a healthy work-life balance. The need for GP training was identified to improve communication skills. Further integration of GPs in health promotion and communal structures would be beneficial.
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Geense WW, van de Glind IM, Visscher TLS, van Achterberg T. Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study. BMC FAMILY PRACTICE 2013; 14:20. [PMID: 23394162 PMCID: PMC3575260 DOI: 10.1186/1471-2296-14-20] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 02/05/2013] [Indexed: 12/02/2022]
Abstract
Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.
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Affiliation(s)
- Wytske W Geense
- Scientific Institute for Quality of Healthcare, IQ healthcare, Radboud University Nijmegen Medical Centre, the Netherlands, P.O. Box 9101, Nijmegen, HB 6500, The Netherlands.
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Gabrys L, Thiel C, Saborowski G, Vogt L, Banzer W. Bewegungsberatung durch Experten aus der Sportwissenschaft. Eine Public Health Strategie zur Erhöhung körperlicher Aktivität bei speziellen Zielgruppen. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12662-012-0271-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Burridge LH, Mitchell GK, Jiwa M, Girgis A. Consultation etiquette in general practice: a qualitative study of what makes it different for lay cancer caregivers. BMC FAMILY PRACTICE 2011; 12:110. [PMID: 21970440 PMCID: PMC3198678 DOI: 10.1186/1471-2296-12-110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 10/05/2011] [Indexed: 01/08/2023]
Abstract
Background It is commonplace for lay caregivers to overlook their own health concerns when supporting someone with advanced cancer. During this time, caregivers' needs as patients are often marginalised by health professionals, including General Practitioners (GPs), who may miss the breadth of caregivers' needs by focusing on the practicalities of caregiving. GPs traditionally rely on patients to raise their concerns, and then respond to these concerns, but caregivers as patients may be disinclined to cue their GP. The norms of engagement when caregivers consult their GP are less defined, and how they interact with their GP regarding their own health is under-explored. This sub-study investigates the norms, assumptions and subtleties which govern caregiver-GP consultations, and explores factors affecting their interaction regarding caregivers' own health concerns. Methods We conducted semi-structured interviews with six lay caregivers and 19 health professionals in Brisbane, Australia, and analyzed the interview transcripts thematically. Results Traditional norms of engagement are subjected to assumptions and expectations which caregivers and GPs bring to the consultation. Practice pressures also influence both parties' capacity and willingness to discuss caregivers' health. Nonetheless, some GPs monitor caregivers' health opportunistically. Their interaction is enhanced by the quality of the caregiver-GP relationship and by the GP's skills. Conclusions Caregivers are caught in a paradox whereby their health needs may become subsumed by the care recipient's needs in a setting where patient needs are normally scrutinised and supported. Caregivers may not raise their health concerns with their GP, who instead may need to cue them that it is timely and safe to do so. The routine use of a prompt may help to address caregivers' needs systematically, but it needs to be complemented by GPs' desire and capacity to engage with patients in a caregiving role. The potential difference GPs can make to the health of these patients is substantial.
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Affiliation(s)
- Letitia H Burridge
- Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospitals, Herston, Queensland 4006, Australia.
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