1
|
Znyk M, Kostrzewski S, Kaleta D. Nurse-led lifestyle counseling in Polish primary care: the effect of current health status and perceived barriers. Front Public Health 2024; 12:1301982. [PMID: 38439750 PMCID: PMC10910074 DOI: 10.3389/fpubh.2024.1301982] [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: 09/25/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Our study included counseling on diet and physical activity, smoking, e-cigarette use, and alcohol consumption. The aim was to examine the correlates of counseling provided by primary care nurses with the health status/health behaviors of nurses and the barriers in the advice provided. Materials and methods In 2022, we conducted a cross-sectional survey among 331 nurses employed in the primary care sector in Lodz. The questionnaire consisted of three sections: characteristics of the patient population receiving treatment and provided with healthy lifestyle counseling by nurses, barriers to the process of assessing, controlling, and guiding patients, and health status/health behaviors of nurses. Results Eighty percent of the nurses in our study provided advice on diet and physical activity to primary care patients. Over 70% of the survey participants performed minimal anti-smoking interventions forsmokers, 67.7% for alcohol drinkers, and 56.8% for e-cigarette users. The correlates of counseling in the field of diet and physical activity turned out to be the knowledge and skills, which enabled nurses to provide advice (OR = 2.57, p < 0.01). The correlates of the conducted minimal anti-smoking interventions in smoking patients were: subjective assessment of overweight and obesity in nurses, knowledge and skills in conducting counseling (OR = 1.92, p < 0.05), and measuring body weight, height and BMI (OR = 2.18, p < 0.01). Among the three most common barriers identified by the nurses in the process of assessing, monitoring, and guiding patients were the opinion that patients are not interested in improving their diet, physical activity, and weight loss (60.7%), lack of time (51.4%), as well as the belief that patients find it too difficult to change their current habits (54.1%). Conclusion The results of our survey indicate that nurses' participation in healthy lifestyle counseling in adult patients is unsatisfactory. Interventions in primary care should be designed considering the specific obstacles nurses may face in leading healthy lifestyles. Further training of nursing staff is required to increase their knowledge on healthy lifestyles.
Collapse
Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, Lodz, Poland
| | | | | |
Collapse
|
2
|
Briguglio M, Cordani C, Langella F, Perazzo P, Pregliasco FE, Banfi G, Wainwright TW. Why Treat Patients with a Major Orthopaedic Surgery Only to Send Them Back to the Vulnerable Conditions That Made Them Sick in the First Place? A Conceptual Scenario to Improve Patient's Journey. Int J Gen Med 2023; 16:4729-4735. [PMID: 37881478 PMCID: PMC10593966 DOI: 10.2147/ijgm.s431055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
Individuals with severe cartilage degeneration of the hip or knee or collapsed vertebrae that cause spine deformities can suffer from joint and neuropathic pain in the back, disuse of the affected limb, and restriction of movements. Surgical intervention is the most widespread and successful solution to date. There is a general belief that eating healthy and staying physically and mentally active might have a preventive role against musculoskeletal disease occurrence, while instead, we are more certain of the benefits deriving from a healthy diet and exercise therapy after major orthopaedic procedures. These aspects are in fact vital components in enhanced recovery after surgery programmes. However, they are applied in hospital settings, are often centre-dependent, and lack primary and tertiary preventive efficacy since end once the patient is discharged. There is the lack of initiatives at the territorial level that ensure a continuum in the patient's journey towards orthopaedic surgery, home transition, and a healthy and long-lasting life. The expert panel advocates the integration of an intermediate lifestyle clinic that promotes healthy eating, physical activity, and sleep hygiene. In this facility directed by professionals in enhancing recovery after surgery, patients can be referred after the surgical indication and before home discharge. Surgery is in fact a moment when individuals are more curious to do their best to heal and stay healthy, representing a timepoint and opportunity for educating patients on how lifestyle changes may optimise not only their surgical recovery but also long-term future health state.
Collapse
Affiliation(s)
- Matteo Briguglio
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical, and Dental Sciences, University “La Statale”, Milan, Italy
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | | | - Paolo Perazzo
- Intensive Care Unit, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Fabrizio Ernesto Pregliasco
- Health Management, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe Banfi
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| |
Collapse
|
3
|
Gurné FL, Svensson PA, Björkman I, Lidén E, Jakobsson S. Seeking lifestyle counselling at primary health care centres: a cross-sectional study in the Swedish population. BMC PRIMARY CARE 2023; 24:74. [PMID: 36941550 PMCID: PMC10026786 DOI: 10.1186/s12875-023-02035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Millions of people follow an unhealthy lifestyle in terms of tobacco consumption, hazardous use of alcohol, poor eating habits, and insufficient physical activity. Healthy lifestyles can to a large extent prevent and/or delay progression of non-communicable diseases. Factors influencing persons health-seeking behaviour regarding unhealthy lifestyles are of importance for sustainable health-promotive and disease-preventive work in primary health care. Generally, lifestyle interventions within primary health care are seen as feasible, but rarely reach all members of the general population. Few studies have been conducted about the likelihood among the general population to voluntarily contact a primary health care centre for support regarding lifestyle changes. The present study therefore aimed to investigate the general population's likelihood of contacting a primary health care centre regarding their lifestyles, and factors associated with a lower such likelihood. METHODS A probability sample of adults living in Sweden (n = 3 750) were invited to participate in a cross-sectional survey regarding how societal developments affect attitudes and behaviours of the adult Swedish population. Data were collected between September and December 2020. Participants completed a questionnaire about lifestyle changes, and the data were analysed using descriptive statistics, Chi-square test and logistic regression analysis. RESULTS The response rate was 52.0% (n = 1 896). Few persons responded that they would be likely to contact a primary health care centre for support regarding their lifestyles. Factors predicting a lower likelihood of contacting primary health care included few yearly visits to a primary health care centre, male sex, and living in a rural area. CONCLUSIONS Primary health care centres are not the first choice for lifestyle counselling for the majority of adults living in Sweden. We have identified factors predicting low likelihood of using the support available at these centres. In order to work with sustainable and visible health-promotive and disease-preventive strategies at primary health care centres, these settings need to find valid methods to involve and collaborate with the members of the general community, to meet the needs of a population struggling with unhealthy lifestyles.
Collapse
Affiliation(s)
- Frida Lundin Gurné
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden.
| | - Per-Arne Svensson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
| | - Ida Björkman
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Eva Lidén
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
| |
Collapse
|
4
|
Gadiraju P, Dehury RK, Singh P, Vanlalhruaii C, Dehury P, Devaraju K, Behera S. Behavioral interventions towards knowledge and awareness of reproductive cancer care: A study on select Indians using an online survey. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:371. [PMID: 36618477 PMCID: PMC9818615 DOI: 10.4103/jehp.jehp_453_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The behavioral aspects of human beings influence the incidences of cancer cases directly and indirectly. The factors like positive thinking and motivation were found to change the behavior toward knowledge and awareness of cancer. The main objective of the study is to assess the knowledge and awareness of select Indians about reproductive cancer. MATERIALS AND METHODS The online survey method assessed various components of knowledge and awareness about reproductive cancer. A Google Form has been distributed through social media platforms such as e-mail, Instagram, Facebook, and WhatsApp. The coded data has been computed in SPSS (version 25) by IBM (USA) for the analysis. Univariate and bivariate data analysis has been drawn to justify the objective. RESULTS Nearly 68 percent of the respondents were aware of reproductive cancer. Among them, 17 percent know about cervical cancer, and 12.5 percent have awareness about breast cancer. Electronic and print media (41.2 percent) were major sources of information about reproductive cancer. Nearly 48 percent of respondents reported that multiple sexual partners and poor sexual hygiene were risk factors for reproductive cancer. Around 57 percent of respondents reported reproductive cancer is preventable, 59 percent knew about cancer screening, and 63.5 percent knew the treatment process. The gender of the respondents was associated (p-value = 0.002) with awareness of reproductive cancer. It has been found that there is a significant association between knowledge of screening tests and the treatment process of reproductive cancer. The marital status of respondents is strongly associated (p-value = 0.000) with the awareness of reproductive cancer. CONCLUSION The factors like knowledge of reproductive cancer and awareness proceed as an important role in cancer prevention. A gender-neutral cancer awareness program is needed to increase cancer awareness irrespective of marital status.
Collapse
Affiliation(s)
- Padmaja Gadiraju
- Centre for Health Psychology, School of Medical Sciences, University of Hyderabad, Telangana, India
| | | | - Punam Singh
- School of Management Studies, University of Hyderabad, Telangana, India
| | - C. Vanlalhruaii
- Centre for Health Psychology, School of Medical Sciences, University of Hyderabad, Telangana, India
| | - Parthsarathi Dehury
- Centre for Health Psychology, School of Medical Sciences, University of Hyderabad, Telangana, India
- Tata Institute of Social Sciences, Mumbai, Maharastra, India
| | - Kadari Devaraju
- Centre for Health Psychology, School of Medical Sciences, University of Hyderabad, Telangana, India
- Department of Psychology, Osmania University, Telangana, India
| | - Sangita Behera
- Centre for Health Psychology, School of Medical Sciences, University of Hyderabad, Telangana, India
| |
Collapse
|
5
|
Vrkatić A, Grujičić M, Jovičić-Bata J, Novaković B. Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners. Healthcare (Basel) 2022; 10:2222. [PMID: 36360563 PMCID: PMC9691229 DOI: 10.3390/healthcare10112222] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 08/04/2023] Open
Abstract
Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.
Collapse
Affiliation(s)
- Aleksandra Vrkatić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Maja Grujičić
- Department of General Education Subjects, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Jelena Jovičić-Bata
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Budimka Novaković
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| |
Collapse
|
6
|
Adelsjö I, Nilsson L, Hellström A, Ekstedt M, Lehnbom EC. Communication about medication management during patient-physician consultations in primary care: a participant observation study. BMJ Open 2022; 12:e062148. [PMID: 36328391 PMCID: PMC9639081 DOI: 10.1136/bmjopen-2022-062148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To explore communication about medication management during annual consultations in primary care. DESIGN passive participant observations of primary care consultations. SETTING Two primary care centres in southern Sweden. PARTICIPANTS Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis. RESULTS Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further. CONCLUSION Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.
Collapse
Affiliation(s)
- Igor Adelsjö
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
| | - Lina Nilsson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Stockholm, Sweden
| | - Elin Christina Lehnbom
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
- Department of Pharmacy, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
| |
Collapse
|
7
|
Kromme NMH, Ahaus KTB, Gans ROB, van de Wiel HBM. Internists’ ambivalence toward their role in health counseling and promotion: A qualitative study on the internists’ beliefs and attitudes. PLoS One 2022; 17:e0273848. [PMID: 36048849 PMCID: PMC9436108 DOI: 10.1371/journal.pone.0273848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Crucial to its success is that physicians enhance their competence in Lifestyle Medicine and take on their role as Health Advocates in Health Counseling and Promotion (HC&P). However, studies on patients’ views of lifestyle counseling in clinical practice demonstrate that many patients neither perceived a need to adopt a healthy lifestyle nor having had any discussion with their physician about their lifestyle. This study is part of a participatory action research project focusing on identifying areas of improvement for health promotion in the practice of internists. Within this project, we interviewed 28 internists from six different subspecialties of an academic medical center in the Netherlands. This study aims to gain insight into how internists understand their role in HC&P by a qualitative analysis of their beliefs and attitudes in the interview data. Participants claimed that promoting a healthy lifestyle is important. However, they also reflected a whole system of beliefs that led to an ambivalent attitude toward their role in HC&P. We demonstrate that little belief in the success of HC&P nurtured ambivalence about the internists’ role and their tasks and responsibilities. Ambivalence appeared to be reinforced by beliefs about the ability and motivation of patients, the internists’ motivational skills, and the patient-doctor relationship, and by barriers such as lack of time and collaboration with General Practitioners. When participants viewed HC&P as a part of their treatment and believed patients were motivated, they were less ambivalent about their role in HC&P. Based on our data we developed a conceptual framework that may inform the development of the competences of the Health Advocate role of internists in education and practice.
Collapse
Affiliation(s)
- Nicolien M. H. Kromme
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Kees T. B. Ahaus
- Erasmus School of Health Policy & Management Health Services Management & Organization (HSMO), Rotterdam, The Netherlands
| | - Reinold O. B. Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry B. M. van de Wiel
- Wenckebach Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
8
|
Hall LH, Thorneloe R, Rodriguez-Lopez R, Grice A, Thorat MA, Bradbury K, Kamble MW, Okoli GN, Powell D, Beeken RJ. Delivering brief physical activity interventions in primary care: a systematic review. Br J Gen Pract 2022; 72:e209-e216. [PMID: 34782318 PMCID: PMC8597771 DOI: 10.3399/bjgp.2021.0312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Physical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown. AIM To examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity. DESIGN AND SETTING A mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results. METHOD CINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model. RESULTS After screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%-100% and 0.6%-100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers - including a lack of time and training/guidelines - remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients' receptivity to advice. CONCLUSION PA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals' confidence in their delivery.
Collapse
Affiliation(s)
- Louise H Hall
- National Institute for Health Research (NIHR) in-practice fellow
| | - Rachael Thorneloe
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield
| | | | - Adam Grice
- National Institute for Health Research (NIHR) in-practice fellow
| | - Mangesh A Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Katherine Bradbury
- NIHR Southampton Biomedical Research Centre, NIHR Applied Research Collaboration Wessex, Southampton
| | | | - Grace N Okoli
- Institute of Population Health Sciences, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Daniel Powell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen
| | | |
Collapse
|
9
|
Expectations about check-up examinations among Swiss residents: A nationwide population-based cross-sectional survey. PLoS One 2021; 16:e0254700. [PMID: 34288961 PMCID: PMC8294504 DOI: 10.1371/journal.pone.0254700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION General health check-up examinations in asymptomatic adults have not been shown to be beneficial. Instead, opportunistic prevention during regular primary care consultations is most cost-effective and recommended. The study aimed to elucidate the expectations about check-ups of the general Swiss population. METHODS A nationwide cross-sectional telephone survey was conducted in a representative sample of the population, stratified by sex, age, and language in November 2019. RESULTS Data of 1077 respondents were analysed. Mean age was 45 years (range 18 to 89), and 51% were female. Overall, 40% of respondents expected to have check-up examinations (yearly: 41.6%), and 42% expected opportunistic prevention. Most expected check-up interventions were sex-specific such as mammography (89% of women), Pap smear test (89% of women), and blood test of prostate-specific antigen (81% of men). The least favoured ones related to counselling (tobacco: 27%; alcohol abuse: 29%). Most significant predictors of positive check-up expectations were being male (OR = 1.45, CI: 1.02-2.05 P = 0.04)), age between 45 and 59 years old (OR = 2.03, CI: 1.27-3.23, P = 0.003 vs. 18 to 29 years), having a degree from professional (OR = 1.73, 95% CIs: 1.11-2.69, P 0.015) or, middle school (OR = 1.99, 95% CIs:1.04-3.78, P = 0.037) or university (OR = 1.66, 95% CIs: 1.06-2.61, P< 0.001, vs. secondary school) and the more importance attributed to regularly checking one's health (OR = 2.12, 95% CIs: 1.70-2.36, P < 0.001). CONCLUSIONS Almost half of the population expected to have mostly yearly check-up examinations in addition to regular care, which is in contradiction to recommendations. This behaviour impacts the rational use of health care resources and must be considered by physicians and given the active role of patients in the health care system.
Collapse
|
10
|
Krachler B, Jerdén L, Tönnesen H, Lindén C. Medical licensing examinations in both Sweden and the US favor pharmacology over lifestyle. Prev Med Rep 2021; 23:101453. [PMID: 34194960 PMCID: PMC8227799 DOI: 10.1016/j.pmedr.2021.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
Lifestyle is a causative factor in most non-communicable diseases. Medical licensing examinations emphasize pharmacology over lifestyle. Future doctors in Sweden and US may not be equipped to address lifestyle-factors.
Low priority of disease prevention and health promotion in medical education may contribute to lack of lifestyle-counseling in clinical practice. Pharmacology-related knowledge is valued 5 times higher compared to lifestyle-related knowledge in examinations on noncommunicable diseases (NCDs) in undergraduate medical education in Sweden. This study aims to establish (i) whether medical licensing examinations are biased to favor pharmacology- over lifestyle-related knowledge and (ii) whether such a bias is present in both Sweden and the US. We identified 204 NCD-related questions from previous Swedish licensing examinations, and 77 cases from a U.S. question bank commonly used to prepare for the United States Medical Licensing Examination® (USMLE®) Step 3. With the help of expected correct answers, we determined distribution of points attainable for knowledge in the respective category (lifestyle / pharmacology / other) for 5 major NCDs: coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and stroke. The percentage of points attainable for lifestyle-related knowledge was 6.7 (95% CI 4.1–9.3) in Sweden and 4.6 (95%CI 0.0–9.1) in the U.S. The respective percentages for pharmacology-related knowledge were 32.6 (95% CI 26.3–38.8) and 44.5 (95% CI 33.2–55.8) percent. The pharmacology vs. lifestyle-quotas were 4.9 in Sweden and 9.8 in the U.S. Likelihoods of equal emphasis on lifestyle and pharmacology in NCDs was < 0.001 in both countries. There is a marked preference for pharmacology over lifestyle in medical licensing examinations in both Sweden and the U.S. Newly qualified doctors may be inadequately prepared to address preventable causes of NCDs.
Collapse
Affiliation(s)
- B Krachler
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - L Jerdén
- Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - H Tönnesen
- Clinical Health Promotion Centre, WHO-CC, Region Skåne and Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - C Lindén
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
| |
Collapse
|
11
|
Jakobsen PR, Christensen JR, Nielsen JB, Søndergaard J, Ejg Jarbøl D, Olsen MH, Nielsen JS, Kristensen JK, Brandt CJ. Identification of Important Factors Affecting Use of Digital Individualised Coaching and Treatment of Type 2 Diabetes in General Practice: A Qualitative Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083924. [PMID: 33917999 PMCID: PMC8068375 DOI: 10.3390/ijerph18083924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022]
Abstract
Most type 2 diabetes patients are treated in general practice and there is a need of developing and implementing efficient lifestyle interventions. eHealth interventions have shown to be effective in promoting a healthy lifestyle. The purpose of this study was to test the feasibility, including the identification of factors of importance, when offering digital lifestyle coaching to type 2 diabetes patients in general practice. We conducted a qualitative feasibility study with focus group interviews in four general practices. We identified two overall themes and four subthemes: (1) the distribution of roles and lifestyle interventions in general practice (subthemes: external and internal distribution of roles) and (2) the pros and cons for digital lifestyle interventions in general practice (subthemes: access to real life data and change in daily routines). We conclude that for digital lifestyle coaching to be feasible in a general practice setting, it was of great importance that the general practitioners and practice nurses knew the role and content of the intervention. In general, there was a positive attitude in the general practice setting towards referring type 2 diabetes patients to digital lifestyle intervention if it was easy to refer the patients and if easily understandable and accessible feedback was implemented into the electronic health record. It was important that the digital lifestyle intervention was flexible and offered healthcare providers in general practice an opportunity to follow the type 2 diabetes patient closely.
Collapse
Affiliation(s)
- Pernille Ravn Jakobsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (J.R.C.); (J.B.N.); (J.S.); (D.E.J.); (C.J.B.)
- Correspondence: ; Tel.: +45-20775905
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (J.R.C.); (J.B.N.); (J.S.); (D.E.J.); (C.J.B.)
- Research Unit of User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (J.R.C.); (J.B.N.); (J.S.); (D.E.J.); (C.J.B.)
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (J.R.C.); (J.B.N.); (J.S.); (D.E.J.); (C.J.B.)
- Steno Diabetes Center, Odense University Hospital, 5000 Odense C, Denmark;
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (J.R.C.); (J.B.N.); (J.S.); (D.E.J.); (C.J.B.)
| | - Michael Hecht Olsen
- Department of Internal Medicine and Steno Diabetes Center Zealand, Holbaek Hospital, 4300 Holbaek, Denmark;
- Department for Regional Health Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Jens Steen Nielsen
- Steno Diabetes Center, Odense University Hospital, 5000 Odense C, Denmark;
- Danish Center for Strategic Research in Type 2 Diabetes, Steno Diabetes Center Odense, Odense University Hospital, 5000 Odense C, Denmark
| | | | - Carl J. Brandt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (J.R.C.); (J.B.N.); (J.S.); (D.E.J.); (C.J.B.)
- Steno Diabetes Center, Odense University Hospital, 5000 Odense C, Denmark;
- Liva Healthcare, 1434 Copenhagen, Denmark
| |
Collapse
|
12
|
Páscoa R, Teixeira A, Gregório M, Carvalho R, Martins C. Patients' Perspectives about Lifestyle Behaviors and Health in the Context of Family Medicine: A Cross-Sectional Study in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062981. [PMID: 33799435 PMCID: PMC8001049 DOI: 10.3390/ijerph18062981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
Lifestyle interventions are recognized as essential in the prevention and treatment of non-communicable diseases. Previous studies have shown that Portuguese patients tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, and seem unaware that behavioral risks are the main modifiable risk factors. The study aimed to analyze patients’ perspectives about lifestyle behaviors and health in the context of family medicine in Portugal. A population-based cross-sectional study was carried out in Portugal (the mainland). A total of 900 Portuguese patients aged ≥20 years, representative of the population, were surveyed using face-to-face questionnaires. Participants were selected by the random route method. Descriptive statistics and non-parametric tests were performed to evaluate differences between the personal beliefs and the personal behavior self-assessment, as well as between the level of importance given to the family doctor to address health behaviors and the reported approach implemented by the family doctor, and its association with bio-demographic variables. The results indicate that the vast majority of this Portuguese cohort has informed beliefs regarding lifestyle behaviors, tends to overestimate their own behavior self-assessment, and strongly agrees that it is important that their family doctor asks/advises on these lifestyle behaviors, although the proportion of those who totally agree that their family doctor usually does this is significantly lower. Differences concerning bio-demographic variables were found. Future research directions should focus on the politics, economics, and policy aspects that may have an impact in this area. It will also be important to understand more broadly the relationships between lifestyle behaviors and clinical, physical, and sociodemographic variables.
Collapse
Affiliation(s)
- Rosália Páscoa
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (A.T.); (M.G.); (C.M.)
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Correspondence: ; Tel.: +351-220-426-600
| | - Andreia Teixeira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (A.T.); (M.G.); (C.M.)
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Instituto Politécnico de Viana do Castelo (IPVC), 4900-347 Viana do Castelo, Portugal
| | - Micaela Gregório
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (A.T.); (M.G.); (C.M.)
| | - Rosa Carvalho
- #H4A Primary Healthcare Research Network, 4460-027 Porto, Portugal;
| | - Carlos Martins
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (A.T.); (M.G.); (C.M.)
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- #H4A Primary Healthcare Research Network, 4460-027 Porto, Portugal;
| |
Collapse
|
13
|
Abstract
Approximately 30-50% of persons living with HIV manifest some degree of neurocognitive impairment. Even mild-to-moderate forms of HIV-associated neurocognitive disorders (HAND) can result in difficulties with everyday functioning, such as suboptimal medication adherence and impaired driving. Despite the pervasive presence and consequences of HAND, there is a significant unmet need to develop effective behavioral strategies to reduce the incidence and consequences of HAND. Although there is an absence of evidence-based behavioral interventions specific to HAND, the literature reviewed in this chapter suggest the following modifiable lifestyle factors as intervention targets: physical activity, diet, sleep, and antiretroviral medication adherence. Adoption and maintenance of these healthy lifestyle factors may reduce inflammation and oxidative stress, which, in turn, may reduce the incidence and/or severity of HAND.
Collapse
Affiliation(s)
- Jessica L Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brook Henry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
| |
Collapse
|
14
|
Abstract
BACKGROUND/OBJECTIVES The primary objective of this study was to explore physicians' adherence to the dietary pattern known as the Mediterranean diet (MD). As a secondary objective we assessed physicians' awareness on the benefits of the MD and of the possibility of prescribing it. SUBJECTS/METHODS Physicians' adherence to the MD was evaluated through the Spanish associations SEMERGEN and CAMFIC, who sent the validated PREDIMED screener to their affiliates. The results reflected a high, medium, low or very low level of adherence depending on total score. The sample was drawn between 2014 and 2016. The second questionnaire evaluated the physicians' knowledge of the MD and their opinion about recommending it. RESULTS The PREDIMED test was answered by 422 Spanish physicians. In 8 out of 14 questions, more than 50% of the individuals scored only 1 point. However, 3 questions resulted in 1 point being scored by almost all physicians. Thus, on average, 55% of questions obtained 1-point scoring. The second questionnaire was answered by 212 physicians; 70% of them considered themselves to be aware of the benefits of the MD. More than 60% said they could invest 5 min of their time to recommend the MD. CONCLUSIONS Primary care physicians do not show a high level of adherence to the MD and emphasize the need for creating tools to evaluate it in their patients. This research can be useful as both a database and a justification for the creation of a new protocol to help physicians increase their own and their patients' MD adherence.
Collapse
|
15
|
Zimmermann M, Chong AK, Vechiu C, Papa A. Psychometric properties of a measure to assess beliefs about modifiable behavior and emotional distress. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.mhp.2020.200188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
16
|
Henderson V, Madrigal JM, Handler A. A mixed methods study: Midlife African American women's knowledge, beliefs, and barriers to well-woman visit, flu vaccine, and mammogram use. J Women Aging 2020; 32:292-313. [PMID: 30466373 PMCID: PMC6531362 DOI: 10.1080/08952841.2018.1549433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
African American women (AAW) are particularly at risk for deleterious health outcomes that might be mitigated through increased preventive care use. A mixed methods study that examined relationships between knowledge of, beliefs about, and barriers to well-woman visits, flu vaccines, and mammograms was conducted with midlife AAW who participated in an online survey (n = 124) and in-depth interviews (n = 19). Findings showed that greater knowledge of preventive service recommendations and positive patient-provider relationships were associated with greater preventive service use. Flu vaccines were significantly underused. Study implications inform strategies to increase preventive care utilization among AAW and increase capacities to improve health disparities.
Collapse
Affiliation(s)
- Vida Henderson
- University of Illinois Cancer Center, 818 S Wolcott Ave. MC 709,
Chicago, Illinois 60612
| | - Jessica M. Madrigal
- University of Illinois School of Public Health, 1603 W. Taylor St.,
Chicago, Illinois 60612,
| | - Arden Handler
- University of Illinois School of Public Health, 1603 W. Taylor
St,.Chicago, Illinois 60612,
| |
Collapse
|
17
|
Kino S, Bernabé E, Sabbah W. Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234642. [PMID: 31766584 PMCID: PMC6926506 DOI: 10.3390/ijerph16234642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 01/03/2023]
Abstract
This study examined inequalities in dental check-ups and medical screenings using subjective and objective socioeconomic indicators. Data from 23,464 adults, aged 20 years old and over, who participated in a multi-national survey across Europe (Eurobarometer 72.3) were analysed. Participants’ socioeconomic position (SEP) was measured by education, difficulty in paying bills and subjective social status. Use of preventive services was measured by attendance for dental check-ups, cancer and cardiovascular screenings in the past 12 months. Socioeconomic inequalities were assessed in two-level logistic regression (adults nested within countries), adjusting for demographic factors and type of healthcare system. There were apparent social inequalities in using all three preventive services. However, only dental check-ups showed consistent and significant inequalities across all socioeconomic indicators with those in the bottom groups in education (odds ratio: 0.51; 95% confidence interval: 0.46–0.55), difficulty in paying bills (OR: 0.64; 95% CI: 0.59–0.72) and subjective social status (OR: 0.63; 95% CI: 0.57–0.69) having lower odds of reporting dental check-ups in the past 12 months than those in the top groups. Cancer screening was not associated with difficulty in paying bills whereas cardiovascular disease screening was not associated with education and subjective social status. Despite the availability of universal health coverage, there were clear social gradients in using preventive services particularly across education and subjective social status groups. The stronger and more consistent gradients observed in dental check-ups compared to cancer and cardiovascular screening could be attributed to difference in the level of coverage of dental and medical services in Europe.
Collapse
Affiliation(s)
- Shiho Kino
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University of Boston, Boston, MA 02115, USA;
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE5 9RS, UK;
- Correspondence:
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE5 9RS, UK;
| |
Collapse
|
18
|
Znyk M, Polańska K, Wojtysiak P, Szulc M, Bąk-Romaniszyn L, Makowiec-Dąbrowska T, Zajdel-Całkowska J, Kaleta D. Predictors of Counselling Related to a Healthy Lifestyle Carried Out by a General Practitioner. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224475. [PMID: 31739411 PMCID: PMC6888170 DOI: 10.3390/ijerph16224475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 02/05/2023]
Abstract
The aim of the study was to assess whether general practitioners (GPs) monitor and evaluate the health behavior of their patients in the field of a diet, physical activity, and weight control, and whether they provide appropriate counselling as part of this evaluation. Predictors of those activities among physicians were also determined. The cross-sectional study was conducted in the Piotrkowski district among 200 GPs. The questionnaire covered socio-demographic data and lifestyle characteristics of the physicians, their role as healthy lifestyle providers, and whether they assess lifestyle characteristics of their patients and perform healthy lifestyle counselling. More than 60% of the GPs did not evaluate lifestyle features during their patients’ examination. In total, 56% of the GPs provided healthy lifestyle recommendations among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations, and 73% of GPs provided recommendations to patients with chronic diseases related to lifestyle. The study showed that the chance to assess lifestyle characteristics of the patients was significantly higher for the GPs who believed that they were obliged to do so (OR = 6.5; p = 0.002). The chance to recommend a healthy lifestyle among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations was 5.9 times higher among the GPs working in the public sector (p < 0.001) and 16.3 times higher for these who believed that they had sufficient knowledge to provide the advice (p = 0.02). The following predictors of providing a healthy lifestyle counselling among patients with diagnosed chronic lifestyle-related diseases were identified: conviction that a GPs is obligated to provide it (OR = 4.4; p = 0.02), sufficient knowledge (OR = 8.7; p = 0.01), and following health recommendations by themselves (OR = 3.9; p = 0.04). Conclusions: The identified predictors are crucial for the development of appropriate strategies aiming at increasing GPs’ involvement in preventive measures and consequently at improving the population’s health.
Collapse
Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (P.W.); (M.S.); (D.K.)
- Correspondence: ; Tel.: +48-426-781-688
| | - Kinga Polańska
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (P.W.); (M.S.); (D.K.)
| | - Piotr Wojtysiak
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (P.W.); (M.S.); (D.K.)
| | - Michał Szulc
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (P.W.); (M.S.); (D.K.)
| | - Leokadia Bąk-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Teresa Makowiec-Dąbrowska
- Department of Work Physiology and Ergonomics, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland;
| | | | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (P.W.); (M.S.); (D.K.)
| |
Collapse
|
19
|
Král N, de Waard AKM, Schellevis FG, Korevaar JC, Lionis C, Carlsson AC, Sønderlund AL, Søndergaard J, Larsen LB, Hollander M, Thilsing T, Angelaki A, de Wit NJ, Seifert B. What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group. Eur J Gen Pract 2019; 25:101-108. [PMID: 31411091 PMCID: PMC6713135 DOI: 10.1080/13814788.2019.1641195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Selective prevention of cardiometabolic diseases (CMD)—that is, preventive measures specifically targeting the high-risk population—may represent the most effective approach for mitigating rising CMD rates. Objectives: To develop a universal concept of selective CMD prevention that can guide implementation within European primary care. Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round. Results: In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated. Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.
Collapse
Affiliation(s)
- Norbert Král
- a Institute of General Practice, First Faculty of Medicine, Charles University , Prague , Czech Republic
| | - Anne-Karien M de Waard
- b Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - François G Schellevis
- c Nivel (Netherlands Institute for Health Services Research) , Utrecht , the Netherlands.,d Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers , Amsterdam , the Netherlands
| | - Joke C Korevaar
- c Nivel (Netherlands Institute for Health Services Research) , Utrecht , the Netherlands
| | - Christos Lionis
- e Clinic of Social and Family Medicine, School of Medicine, University of Crete , Greece
| | - Axel C Carlsson
- f Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute , Stockholm , Sweden.,g Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University , Uppsala , Sweden
| | - Anders Larrabee Sønderlund
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Jens Søndergaard
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Lars Bruun Larsen
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Monika Hollander
- b Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Trine Thilsing
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Agapi Angelaki
- e Clinic of Social and Family Medicine, School of Medicine, University of Crete , Greece
| | - Niek J de Wit
- b Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Bohumil Seifert
- a Institute of General Practice, First Faculty of Medicine, Charles University , Prague , Czech Republic
| |
Collapse
|
20
|
Hamilton K, Henderson J, Burton E, Hagger MS. Discussing lifestyle behaviors: perspectives and experiences of general practitioners. Health Psychol Behav Med 2019; 7:290-307. [PMID: 34040852 PMCID: PMC8114406 DOI: 10.1080/21642850.2019.1648216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Initiatives aimed at increasing participation in preventive health behaviors has been identified as a priority for addressing the increasing incidence of non-communicable chronic disease. General practice is an existing network that can be leveraged to intervene and promote messages for health behavior change. We aimed to explore the extent to which ‘lifestyle’ behaviors are discussed by general practitioners (GPs) with their patients in their practices, and the context and content of these discussions. Methods: GPs (N = 26) practising in Australian clinics participated in semi-structured interviews. Data were analyzed using an inductive thematic analysis. Results: Results showed discussions of lifestyle behaviors were brief, but relatively frequent and often initiated by the GP. GPs generally provided basic advice and education that was often ad-hoc and in reaction to prompts from the patient. GPs recognized the importance of addressing lifestyle behaviors in practice, but also highlighted substantive barriers that limit the initiation of these discussions. These included patient readiness for change, patient acceptance and openness, patient accountability and responsibility, patient background factors, GPs’ role and knowledge, GP financial implications, GP-patient relationship, and lack of time. Conclusions: Current findings provide important preliminary knowledge on the extent to which Australian GPs discuss lifestyle behavior change with patients during routine consultations, the context and content of these discussions, and barriers to initiating these discussions. Further research should seek to gain a better understanding of barriers and identify strategies to mitigate their impact. This might maximize the potential for GPs to promote adaptive lifestyle behavior change for improving patient health.
Collapse
Affiliation(s)
- Kyra Hamilton
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,School of Psychology, Health Psychology and Behavioral Medicine Research Group, Curtin University, Perth, Western Australia
| | - Joanna Henderson
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Emma Burton
- School of Psychology, Health Psychology and Behavioral Medicine Research Group, Curtin University, Perth, Western Australia
| | - Martin S Hagger
- Psychological Sciences, University of California, Merced, CA, USA.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
21
|
Mäntyselkä P, Kautiainen H, Miettola J. Beliefs and attitudes towards lifestyle change and risks in primary care - a community-based study. BMC Public Health 2019; 19:1049. [PMID: 31382938 PMCID: PMC6683394 DOI: 10.1186/s12889-019-7377-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Promoting a positive lifestyle change is a challenge for primary health care. The aim of this study was to analyze health and risk-related beliefs and attitudes in relation to lifestyle and lifestyle change in a rural community. Methods The study was based on a five-year follow-up data of the Lapinlahti study (N = 361). The same structured questionnaire was used at baseline and follow-up with lifestyle items. These were ranked as unhealthy (− 1), neutral (0) or healthy (+ 1). At baseline, participants took a stand on 29 statements related to beliefs and attitudes towards health and health promotion on a 5-point Likert scale. A factor analysis yielded two attitude factors (Factor 1 = underrating risks/resistant to change); (Factor 2 = helplessness/pessimism). The factors were divided into tertiles. Results There was a linear positive trend (P < 0.001) in baseline lifestyle scores between the tertiles of Factor 1. A positive follow-up change of lifestyle score was found in all tertiles of Factor 1. For Factor 2, the difference between tertiles at baseline was non-significant. There was a significant positive change in all tertiles of Factor 2. Those who were underrating/ resistant but not helpless/pessimistic had the most significant positive lifestyle change. Those who were underrating/resistant and helpless/pessimistic did not improve their lifestyles. Conclusions Beliefs and attitudes are related to lifestyle. Subjects with underrating and resistant attitudes with pessimism/helplessness seem to have a low potential for lifestyle change while those with resistant attitudes without pessimism and helplessness may have the most significant potential for lifestyle change. These findings suggest that it is possible to identify different groups of people with different needs and readiness and ability for health behavior change.
Collapse
Affiliation(s)
- Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition (General Practice), School of Medicine, University of Eastern Finland, 70211-FIN, P.O.Box 1627, Kuopio, Finland. .,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Juhani Miettola
- Institute of Public Health and Clinical Nutrition (General Practice), School of Medicine, University of Eastern Finland, 70211-FIN, P.O.Box 1627, Kuopio, Finland
| |
Collapse
|
22
|
Vörös K, Márkus B, Hargittay C, Sisak O, Kalabay L. Perceived cardiovascular risk and attitude towards lifestyle change. Fam Pract 2018; 35:712-717. [PMID: 29897431 DOI: 10.1093/fampra/cmy028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are prominent cause of death. Lifestyle change is effective in decreasing mortality. Perception of patients' cardiovascular risk by physicians is a drive for following preventive recommendations. Whether the hazard perceived by patients influences their attitude towards lifestyle is uncertain. OBJECTIVE We hypothesized that high perceived risk would be associated with a stronger determination for lifestyle change, while incorrectly optimistic patients would be less motivated. METHODS Two hundred patients visiting their family physicians were asked to fill out a questionnaire about demographic, clinical and lifestyle characteristics, about their attitude towards lifestyle change and their estimation of their cardiovascular risk. Actual risk was estimated by family physicians based on the national guideline. RESULTS Questionnaires were completed by 80.5% (161/200) of patients approached. Patients underestimated their risk (P < 0.001), mainly because high-/very high-risk patients classified themselves into lower risk categories. The majority of patients were planning a lifestyle change, losing weight being the most popular goal. It was the priority even for some normal weight subjects and for smokers, too. Perceived risk played a marginal role as a determinant of lifestyle change. Underestimation of perceived risk had no effect on patients' motivation. Self-rated obesity was the predictor of three out of five means of change (weight loss, diet, physical activity). CONCLUSION Perceived cardiovascular risk and incorrect optimism about this hazard have minimal, if any, influence on attitude towards lifestyle change. Patients' motivation seems not to be primarily health related.
Collapse
Affiliation(s)
- Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Bernadett Márkus
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Sisak
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
23
|
Jerdén L, Dalton J, Johansson H, Sorensen J, Jenkins P, Weinehall L. Lifestyle counseling in primary care in the United States and Sweden: a comparison of patients' expectations and experiences. Glob Health Action 2018; 11:1438238. [PMID: 29495947 PMCID: PMC5844052 DOI: 10.1080/16549716.2018.1438238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Despite various guidelines, shortcomings in lifestyle counseling in primary care have been demonstrated. Comparisons between countries may provide insight on how to improve such counseling. To the best of our knowledge, studies comparing patients’ views of lifestyle counseling beween the United States (US) and European countries have not been reported. Objectives: To quantify and compare patients’ perspectives in the US and Sweden on primary care providers’ counseling on weight, eating habits, physical activity, smoking, and alcohol consumption. Methods: In a cross-sectional study, 629 patients from Sweden and the US completed a telephone interview about their experiences after a visit to a physician in primary care. The survey focused on patients’ perception of the importance of healthy lifestyle habits, their need to change, their desire to receive support from primary care, and the support they had actually received. Data were analyzed using chi-square or Fisher’s exact test. Results: For three of the four lifestyle habits, the proportion saying they needed to change was higher in the US. The exception was for alcohol, where Swedish subjects indicated a greater need to change. Among those stating a need to change, the proportion saying that they would like to have support from primary care was generally above 80% in both countries. The proportion of US patients reporting that their primary care provider had initiated a discussion of lifestyle modification was, with the exception of alcohol, roughly double the level reported by the Swedish patients. Conclusions: This study demonstrates high and quite similar patient expectations concerning lifestyle counseling in both countries, but more frequent initiation of discussions of most lifestyle issues in US primary care. Further studies, e.g. qualitative interviews with physicians, and medical record reviews, are required to better understand what can explain the differences between countries indicated by the study.
Collapse
Affiliation(s)
- Lars Jerdén
- a Department of Public Health and Clinical Medicine, Epidemiology and Global Health , Umeå University , Umeå , Sweden.,b Center for Clinical Research Dalarna , Falun , Sweden.,c School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - James Dalton
- d Bassett Healthcare Network Research Institute , Cooperstown , NY , USA
| | - Helene Johansson
- a Department of Public Health and Clinical Medicine, Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | - Julie Sorensen
- d Bassett Healthcare Network Research Institute , Cooperstown , NY , USA
| | - Paul Jenkins
- d Bassett Healthcare Network Research Institute , Cooperstown , NY , USA
| | - Lars Weinehall
- a Department of Public Health and Clinical Medicine, Epidemiology and Global Health , Umeå University , Umeå , Sweden
| |
Collapse
|
24
|
Abstract
Background: According to the Wonca International Dictionary for General/Family Practice Quaternary Prevention is defined as: ‘Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.’ The concept of quaternary prevention was initially proposed by Marc Jamoulle and the targets were mainly patients with illness but without a disease. Objectives: The purpose of this opinion article is to open the debate around a new possible definition and a new conceptual model of quaternary prevention based on the belief that quaternary prevention should be present in physicians’ minds for every intervention they suggest to a patient. Discussion: The debate around quaternary prevention is vital in the context of contemporary medicine and has expanded worldwide. The human being may suffer harm from medical interventions from conception, during their childhood, during their entire healthy lifetime as well as during a self-limited disease, a chronic disease, or a terminal disease. The current definition of quaternary prevention has limitations because it excludes patients and medical interventions where a quaternary prevention perspective would be needed and useful to protect patients from harm. In this context, a new definition and conceptual model of quaternary prevention is proposed. Conclusion: In this new proposal, quaternary prevention is defined as an ‘action taken to protect individuals (persons/patients) from medical interventions that are likely to cause more harm than good.’
Collapse
Affiliation(s)
- Carlos Martins
- a Family Medicine, Department of Community Medicine, Information and Decision in Health (MEDCIDS) of the Faculty of Medicine of Porto , Centre for Health Technology and Services Research (CINTESIS) , Porto , Portugal
| | - Maciek Godycki-Cwirko
- b Division of Public Health, Centre for Family and Community Medicine , Medical University of Lodz , Lodz , Poland
| | - Bruno Heleno
- c Chronic Diseases Research Centre, NOVA Medical School/Faculdade de Ciências Médicas , Universidade NOVA de Lisboa , Lisboa , Portugal
| | - John Brodersen
- d Section of General Practice & Research Unit for General Practice, Department of Public Health, Faculty of Health Sciences, Primary Healthcare Research Unit , University of Copenhagen , Region Zealand , Denmark
| |
Collapse
|
25
|
Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A. Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care. BMC FAMILY PRACTICE 2018; 19:139. [PMID: 30131057 PMCID: PMC6103870 DOI: 10.1186/s12875-018-0829-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 08/14/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence-based practice for healthy lifestyle promotion in primary health care is supported internationally by national policies and guidelines but implementation in routine primary health care has been slow. Referral to digital interventions could lead to a larger proportion of patients accessing structured interventions for healthy lifestyle promotion, but such referral might have unknown implications for clinicians with patients accessing such interventions. This qualitative study aimed to explore the perceptions of clinicians in primary care on healthy lifestyle promotion with or without digital screening and intervention. METHODS Focus group interviews were conducted at 10 primary care clinics in Sweden with clinicians from different health professions. Transcribed interviews were analyzed using content analysis, with inspiration from a phenomenological-hermeneutic method involving naïve understanding, structural analysis and comprehensive understanding. RESULTS Two major themes captured clinicians' perceptions on healthy lifestyle promotion: 1) the need for structured professional practice and 2) deficient professional practice as a hinder for implementation. Sub-themes in theme 1 were striving towards professionalism, which for participants meant working in a standardized fashion, with replicable routines regardless of clinic, as well as being able to monitor statistics on individual patient and group levels; and embracing the future with critical optimism, meaning expecting to develop professionally but also being concerned about the consequences of integrating digital tools into primary care, particularly regarding the importance of personal interaction between patient and provider. For theme 2, sub-themes were being in an unmanageable situation, meaning not being able to do what is perceived as best for the patient due to lack of time and resources; and following one's perception, meaning working from a gut feeling, which for our participants also meant deviating from clinical routines. CONCLUSIONS In efforts to increase evidence-based practice and lighten the burden of clinicians in primary care, decision- and policy-makers planning the introduction of digital tools for healthy lifestyle promotion will need to explicitly define their role as complements to face-to-face encounters. Our overriding hope is that this study will contribute to maintaining meaningfulness in the patient-clinician encounter, when digital tools are added to facilitate patient behavior change of unhealthy lifestyle behaviors.
Collapse
Affiliation(s)
- Anne H. Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
| | - Karoline Kolaas
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Gustavsberg Primary Care Clinic, Odelbergs väg 19, Gustavsberg, Sweden
| | - Elisabeth Petersén
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
| | - Preben Bendtsen
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Erik Hedman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Gustavsberg Primary Care Clinic, Odelbergs väg 19, Gustavsberg, Sweden
| | - Catharina Linderoth
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Müssener
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristina Sinadinovic
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
| | - Fredrik Spak
- Chalmers Technological University, Gothenburg, Sweden
| | - Ida Gremyr
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Thurang
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Influenza vaccination in people with type 2 diabetes, coverage, predictors of uptake, and perceptions. Result of the MADIABETES cohort a 7years follow up study. Vaccine 2017; 35:101-108. [DOI: 10.1016/j.vaccine.2016.11.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/18/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
|
28
|
Santiago S, Zazpe I, Gea A, de la Rosa PA, Ruiz-Canela M, Martínez-González MA. Healthy-eating attitudes and the incidence of cardiovascular disease: the SUN cohort. Int J Food Sci Nutr 2016; 68:595-604. [PMID: 28029068 DOI: 10.1080/09637486.2016.1265100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
There is an emerging use of brief dietary questionnaires to investigate diet-health relation. We prospectively assess the association between eating attitudes (yes/no) and incident cardiovascular disease (CVD) in 19,138 participants of the Seguimiento Universidad de Navarra (SUN) Cohort. We calculated a baseline healthy-eating attitudes score (in quartiles), positively weighting answers on more fruit, vegetables, fish and fiber and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. We observed 139 incident cases of CVD. A higher score was associated with a lower risk of CVD [3-5 points Hazard Ratio (HR): 0.38 (95% confidence interval: 0.18-0.81); 6-8 points: 0.57 (0.29-1.12); 9-10 points: 0.31 (0.15-0.67), compared to 0-2 points]. Key contributors were the attitude to increase fruit [HR: 0.59 (0.40-0.87)], vegetables [HR: 0.57 (0.29-1.12)] and fiber intake [HR: 0.69 (0.48-0.98)]. Brief questionnaire on attitudes towards healthy-eating may be a useful tool for the primary prevention of CVD.
Collapse
Affiliation(s)
- Susana Santiago
- a Department of Nutrition and Food Sciences and Physiology , School of Pharmacy, University of Navarra , Navarra , Spain.,b Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona , Spain
| | - Itziar Zazpe
- a Department of Nutrition and Food Sciences and Physiology , School of Pharmacy, University of Navarra , Navarra , Spain.,b Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona , Spain.,c Department of Preventive Medicine and Public Health, School of Medicine , University of Navarra , Navarra , Spain.,d Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III , Madrid , Spain
| | - Alfredo Gea
- b Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona , Spain.,c Department of Preventive Medicine and Public Health, School of Medicine , University of Navarra , Navarra , Spain.,d Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III , Madrid , Spain
| | - Pedro A de la Rosa
- c Department of Preventive Medicine and Public Health, School of Medicine , University of Navarra , Navarra , Spain
| | - Miguel Ruiz-Canela
- b Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona , Spain.,c Department of Preventive Medicine and Public Health, School of Medicine , University of Navarra , Navarra , Spain.,d Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III , Madrid , Spain
| | - Miguel A Martínez-González
- b Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona , Spain.,c Department of Preventive Medicine and Public Health, School of Medicine , University of Navarra , Navarra , Spain.,d Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III , Madrid , Spain.,e Department of Nutrition , Harvard TH Chan School of Public Health , Boston, MA , USA
| |
Collapse
|
29
|
Sá L, Ribeiro O, Azevedo LF, Couto L, Costa-Pereira A, Hespanhol A, Santos P, Martins C. Patients' estimations of the importance of preventive health services: a nationwide, population-based cross-sectional study in Portugal. BMJ Open 2016; 6:e011755. [PMID: 27707825 PMCID: PMC5073585 DOI: 10.1136/bmjopen-2016-011755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine, in the context of primary care preventive health services, the level of importance that Portuguese patients attribute to different preventive activities. DESIGN Cross-sectional study. SETTING Primary Healthcare, Portugal. PARTICIPANTS 1000 Portuguese adults selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. Persons with a cognitive or physical disability that hampered the ability to complete a telephone interview and being a nursing home resident or resident in any other type of collective dwelling were excluded. OUTCOMES Mean level of importance assigned to 20 different medical preventive activities, using a scale of 1-10, with 1 corresponding to 'no importance for you and your health' and 10 indicating 'very important'. RESULTS The mean level of importance assigned to medical preventive activity was 7.70 (95% CI 7.60 to 7.80). Routine blood and urine tests were considered the most important, with an estimated mean of 9.15 (95% CI 9.07 to 9.24), followed by female-specific interventions (Pap smear, mammography and gynaecological and breast ultrasounds), with mean importance ranging from 8.45 (95% CI 8.23 to 8.63) for mammography to 8.56 (95% CI 8.36 to 8.76) for Pap smear. Advice regarding alcohol consumption (6.18; 95% CI 5.96 to 6.39) and tobacco consumption (5.99; 95% CI 5.75 to 6.23) were considered much less important. CONCLUSIONS Our results reveal that Portuguese patients overestimate the importance of preventive medical activities, tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, do not discriminate tests that are important and evidence-based, and seem not be aware of the individualisation of risk. Family physicians should be aware of these optimistic expectations, because these can influence the doctor-patient relationship when discussing these interventions and incorporating personalised risk.
Collapse
Affiliation(s)
- Luísa Sá
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Family Health Unit Nova Via, Porto, Portugal
| | - Orquídea Ribeiro
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Luciana Couto
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Altamiro Costa-Pereira
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Alberto Hespanhol
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Paulo Santos
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| | - Carlos Martins
- Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
| |
Collapse
|
30
|
Walter KN, Wagner JA, Cengiz E, Tamborlane WV, Petry NM. The need for research addressing alcohol use disorder and diabetes. Addiction 2016; 111:763-5. [PMID: 26589363 DOI: 10.1111/add.13187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kimberly N Walter
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Julie A Wagner
- University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Eda Cengiz
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Nancy M Petry
- University of Connecticut School of Medicine, Farmington, Connecticut, USA.
| |
Collapse
|
31
|
Gual A, Zarco J, Colom Farran J, Rehm J. [Early screening and brief intervention in alcohol misuse to improve the treatment of hypertension in primary care]. Med Clin (Barc) 2015; 146:81-5. [PMID: 26520609 DOI: 10.1016/j.medcli.2015.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Antoni Gual
- Unidad de Alcohología, Servicio de Psiquiatría, Instituto de Neurociencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - José Zarco
- Centro de Salud Ibiza, Servicio Madrileño de Salud, Madrid, España
| | - Joan Colom Farran
- Subdirección General de Drogodependencias, Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalitat de Cataluña, Barcelona, España
| | - Jürgen Rehm
- Unidad de Investigación Epidemiológica, Psicología Clínica y Psicoterapia, Universidad Tecnológica de Dresde, Dresde, Alemania; Centre for Addiction and Mental Health, Toronto, Canadá
| | | |
Collapse
|
32
|
Identification of smokers, drinkers and risky drinkers by general practitioners. Drug Alcohol Depend 2015; 154:93-9. [PMID: 26130336 DOI: 10.1016/j.drugalcdep.2015.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/01/2015] [Accepted: 06/08/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Identification of risky substance users by general practitioners (GPs) is important for providing brief interventions or to refer cases to specialized care, but detection rates of risky users are low, with alcohol users being identified less frequently than smokers. METHODS We compared GPs' assessment and patient self-report concerning tobacco use, number of cigarettes smoked daily, alcohol use, alcohol use disorder, and different risky use definitions of 8476 primary care patients from six European countries. Further, we carried out a logistic regression predicting the GPs perception of the patients' alcohol problems. RESULTS GPs identified 88.4% (95% confidence interval (CI): 87.1-89.6%; κ=0.84, 95% CI: 0.83-0.86) of all self-reported smokers but only 64.6% (95% CI: 63.2-65.9%; κ=0.35, 95% CI: 0.33-0.37) of all current drinkers, while they were unable to judge the drinking status of every ninth patient. The GPs' estimation of number of cigarettes smoked daily was slightly lower than the self-report (Δ=0.23 cigarettes/day, p<.001) but both measures were correlated with each other. Of all risky drinkers, defined as having alcohol-related problems or showing risky drinking patterns, 28.7% (95% CI: 25.9-31.4%; κ=0.34, 95% CI: 0.31-0.37) were perceived as having problems with alcohol by the GPs. Patients' self-reported health and social consequences, as well as drinking patterns predicted the GPs' perception of alcohol problems. CONCLUSIONS GPs were more accurate in identifying smokers than drinkers. Concerning risky drinkers, GPs failed to diagnose a sizeable proportion but were able to detect other drinkers whom common recognition approaches had not recognized.
Collapse
|
33
|
Jimenez-Trujillo I, Jiménez-García R, Esteban-Hernández J, Hernández-Barrera V, Carrasco Garrido P, Salinero-Fort MA, Cardenas-Valladolid J, López-de-Andrés A. Predictors of Adherence to Multiple Clinical Preventive Recommendations among Adults with Diabetes in Spain. PLoS One 2015; 10:e0131844. [PMID: 26121575 PMCID: PMC4484803 DOI: 10.1371/journal.pone.0131844] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/05/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study aims to describe adherence to seven clinical preventive services among Spanish adults with diabetes, to compare adherence with people without diabetes and to identify predictor of adherence to multiple practices among adults with diabetes. DESIGN Cross-sectional study based on data obtained from the European Health Survey for Spain 2009 and the Spanish National Health Survey 2011. We analyzed those aged 40-69 years (n= 20,948). Diabetes status was self-reported. The study variables included adherence to blood pressure (BP) checkup, cholesterol measurement, influenza vaccination, dental examination, fecal occult blood test (FOBT), mammography and cytology. Independent variables included socio-demographic characteristics, variables related to health status and lifestyle factors. RESULTS The study sample included 1,647 subjects with diabetes and 19,301 without. Over 90% had measured their BP and cholesterol in the last year, 44.4% received influenza immunization, 36.4% had a dental checkup within the year and only 8.1% underwent a FOBT. Among diabetic women 75.4% had received a mammography and 52.4% a cytology in the recommended periods. The adherence to BP and cholesterol measurements and influenza vaccination was significantly higher among those suffering diabetes and cytology and dental checkup were lower. Only 63.4% of people with diabetes had fulfilled half or more of the recommended practices. Female sex, higher educational level, being married or cohabiting, higher number of chronic conditions and number of physician visits increased the adherence to multiple preventive practices. For each unhealthy lifestyle reported the probability of having a higher adherence level decreased. CONCLUSIONS Acceptable adherence is found for BP and cholesterol checkups and mammography. Unacceptably low rates were found for influenza vaccine, dental care, cytology and FOBT. Moreover, preventive services are provided neither equitably nor efficiently so future research needs to identify individual and organizational factors that allow interventions to reach these subjects with diabetes.
Collapse
Affiliation(s)
- Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Jesus Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Pilar Carrasco Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Miguel A. Salinero-Fort
- Dirección Técnica de Docencia e Investigación, Gerencia Atención Primaria, Madrid, Comunidad de Madrid, Spain
| | - Juan Cardenas-Valladolid
- Dirección Técnica de Docencia e Investigación, Gerencia Atención Primaria, Madrid, Comunidad de Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| |
Collapse
|
34
|
Rosell-Murphy M, Rodriguez-Blanco T, Morán J, Pons-Vigués M, Elorza-Ricart JM, Rodríguez J, Pareja C, Nuin MÁ, Bolíbar B. Variability in screening prevention activities in primary care in Spain: a multilevel analysis. BMC Public Health 2015; 15:473. [PMID: 25947302 PMCID: PMC4440275 DOI: 10.1186/s12889-015-1767-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/21/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite evidence of the benefits of prevention activities, studies have reported only partial integration and great variability of screening in daily clinical practice. The study objectives were: 1) To describe Primary Health Care (PHC) screening for arterial hypertension, dyslipidaemia, obesity, tobacco use, and excessive alcohol consumption in 2008 in 2 regions of Spain, based on electronic health records, and 2) To assess and quantify variability in screening, and identify factors (of patient, general practitioners and PHC team) associated with being screened, that are common throughout the PHC population. METHODS Multicentre, cross-sectional study of individuals aged ≥ 16 years (N = 468,940) who visited the 426 general practitioners (GPs) in 44 PHC teams in Catalonia and Navarre in 2008. OUTCOMES screening for hypertension, dyslipidaemia, obesity, tobacco use, and excessive alcohol consumption. Other variables were considered at the individual (sociodemographics, visits, health problems), GP and PHC team (region among others). Individual and contextual factors associated with the odds of being screened and the variance attributable to each level were identified using the SAS PROC GLIMMIX macro. RESULTS The most prevalent screenings were for dyslipidaemia (64.4%) and hypertension (50.8%); the least prevalent was tobacco use (36.6%). Overall, the odds of being screened were higher for women, older patients, those with more comorbidities, more cardiovascular risk factors, and more frequent office visits, and those assigned to a female GP, a GP with a lower patient load, or a PHC team with a lower percentage of patients older than 65 years. On average, individuals in Navarre were less likely to be screened than those in Catalonia. Hypertension and dyslipidaemia screenings had the least unexplained variability between PHC teams and GPs, respectively, after adjusting for individual and contextual factors. CONCLUSIONS Of the studied screenings, those for obesity, tobacco, and alcohol use were the least prevalent. Attention to screening, especially for tobacco and alcohol, can be greatly improved in the PHC setting.
Collapse
Affiliation(s)
- Magdalena Rosell-Murphy
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
- Equip d'Atenció Primària Serraparera. Institut Català de la Salut, Cerdanyola del Vallès, Spain.
| | - Teresa Rodriguez-Blanco
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
| | - Julio Morán
- Dirección Atención Primaria, Servicio Navarro de Salud - Osasunbidea, Navarra, Spain.
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
| | - Josep M Elorza-Ricart
- SIDIAP, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Jordi Rodríguez
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
- SIDIAP, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Clara Pareja
- Equip d'Atenció Primària La Mina. Institut Català de la Salut, Barcelona, Spain.
| | - María Ángeles Nuin
- Dirección Atención Primaria, Servicio Navarro de Salud - Osasunbidea, Navarra, Spain.
| | - Bonaventura Bolíbar
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
| |
Collapse
|
35
|
Thomas K, Krevers B, Bendtsen P. Long-term impact of a real-world coordinated lifestyle promotion initiative in primary care: a quasi-experimental cross-sectional study. BMC FAMILY PRACTICE 2014; 15:201. [PMID: 25512086 PMCID: PMC4305248 DOI: 10.1186/s12875-014-0201-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/18/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Integration of lifestyle promotion in routine primary care has been suboptimal. Coordinated care models (e.g. screening, brief advice and referral to in-house specialized staff) could facilitate lifestyle promotion practice; they have been shown to increase the quality of services and reduce costs in other areas of care. This study evaluates the long-term impact of a coordinated lifestyle promotion intervention with a multidisciplinary team approach in a primary care setting. METHODS A quasi-experimental, cross-sectional design was used to compare three intervention centres using a coordinated care model and three control centres using a traditional model of lifestyle promotion care. Outcomes were inspired by 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 daily practice of lifestyle promotion and referral; and implementation, of the coordinated care model. The impact was investigated after 3 and 5 years. Data collection involved a patient questionnaire (intervention, n = 433-497; control, n = 455-497), a staff questionnaire (intervention, n = 77-76; control, n = 43-56) and structured interviews with managers (n = 8). The χ(2) test or Fisher exact test with adjustment for clustering by centre was used for the analysis. Problem-driven content analysis was used to analyse the interview data. RESULTS The findings were consistent over time. Intervention centres did not show higher rates for reach of patients or adoption among staff at the 3- or 5-year follow-up. Some conceptual differences between intervention and control staff remained over time in that the intervention staff were more positive on two of eight effectiveness outcomes (one attitude and one competency item) compared with control staff. The Lifestyle team protocol, which included structural opportunities for coordinated care, was implemented at all intervention centres. Lifestyle teams were perceived to have an important role at the centres in driving the lifestyle promotion work forward and being a forum for knowledge exchange. However, resources to refer patients to specialized staff were used inconsistently. CONCLUSIONS The Lifestyle teams may have offered opportunities for lifestyle promotion practice and contributed to enabling conditions at centre level but had limited impact on lifestyle promotion practices.
Collapse
Affiliation(s)
- Kristin Thomas
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Barbro Krevers
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden.
| |
Collapse
|
36
|
Sagner M, Katz D, Egger G, Lianov L, Schulz KH, Braman M, Behbod B, Phillips E, Dysinger W, Ornish D. Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community. Int J Clin Pract 2014; 68:1289-92. [PMID: 25348380 DOI: 10.1111/ijcp.12509] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/25/2014] [Indexed: 01/05/2023] Open
Affiliation(s)
- M Sagner
- European Society of Lifestyle Medicine, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Gelly J, Le Bel J, Aubin-Auger I, Mercier A, Youssef E, Mentre F, Nougairede M, Letrilliart L, Duval X. Profile of French general practitioners providing opportunistic primary preventive care--an observational cross-sectional multicentre study. Fam Pract 2014; 31:445-52. [PMID: 24925928 DOI: 10.1093/fampra/cmu032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preventive services provided opportunistically by GPs are insufficient. Reasons are most often gathered through GPs' self-reports, rather than through independent observation. OBJECTIVE To assess with passive observers, the degree to which French GPs opportunistically perform primary preventive care during routine consultation. METHODS Observational cross-sectional multicentre ancillary study of the French ECOGEN study. The study period extended from 28 November 2011 to 30 April 2012. The inclusion criteria were patients seen by GPs at surgery and home consultations in non-randomized pre-determined half-day blocks per week. The non-inclusion criteria were patient's refusal and consultations initially focused on primary prevention in response to patient's request (ancillary study's specific criterion). Using passive observers, data were collected based on the second version of International Classification of Primary Care. Preventive consultations were defined if at least one problem/diagnosis was considered by consensus as definitely related to primary prevention. For each one of the 128 participating GPs, aggregation of data was performed from all his/her consultations. Determinants of the proportion of preventive consultations per GP were assessed by multivariate linear regression. RESULTS Considering 19003 consultations, the median proportion of preventive consultations per GP was 14.9% (range: 0-78.3%). It decreased with increased proportion of patients aged 18 or less (P = 0.006), with increased proportion of home visits (P = 0.008) and with increased proportion of consultations lasting under 10 minutes (P = 0.02). None of the GPs' personal characteristics were significantly associated. CONCLUSION Primary preventive care activity was related to the characteristics of GPs' patients and practice organizational markers and not to GPs' personal characteristics.
Collapse
Affiliation(s)
- Julien Gelly
- Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris,
| | - Josselin Le Bel
- Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris
| | - Isabelle Aubin-Auger
- Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris
| | - Alain Mercier
- Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, Department of General Practice, University Rouen, F-76000 Rouen
| | - Elodie Youssef
- Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris
| | - France Mentre
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris
| | - Michel Nougairede
- Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris
| | - Laurent Letrilliart
- Department of General Practice, University Claude Bernard, Lyon 1, F-69000 Lyon and
| | - Xavier Duval
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, AP-HP, Hôpital Bichat, INSERM, Centre d'Investigation Clinique (CIC) 007, F-75018 Paris, France
| | | |
Collapse
|
38
|
Bulc M, Švab I, Godycki-Cwirko M. Factors that affect readiness to change lifestyle: a 22-country survey from primary care. Eur J Gen Pract 2014; 21:33-8. [PMID: 24862640 DOI: 10.3109/13814788.2014.912269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The family physician's task in prevention is not only an assessment of patients' health risks but also counselling individual patients. AIM Aim of this primary care based study was to find how patients' characteristics relate to their readiness to change. METHODS This multinational cross-sectional survey was conducted in primary care in 22 European countries, coordinated by EUROPREV. Consecutive attenders from randomly selected family practices answered a questionnaire about attitudes towards prevention and about lifestyle. RESULTS The questionnaire was answered by 7947 patients in 224 primary care practices in 22 European countries. Smoking was reported by 828 women (23.2%) versus 1238 (32.57%) men, unhealthy diet by 637 (11.6%) women versus 830 men (17.62%), risky alcohol consumption by 348 women (8.19%) versus 1009 men (23.07%) and the lack of physical activity by 617 women (12.68%) versus 614 men (16.45%). The need for change was declared by 432 (31.8%) of 1357 risky drinkers, 612 (29.6%) of 2066 smokers, 1210 (82.4%) of 1467 patients with unhealthy diet and by 2456 (30.9%) of all participants, 1231 of them were not physically active at all. Among patients with unhealthy dietary habits, 681 (56.3%) were confident of successfully changing their behaviour, among physically inactive it was 1561 (63.6 %), among smokers 284 (46.4%), and among risky drinkers 214 (49.5%). CONCLUSION More likely to be ready to change unhealthy lifestyles are frequent attenders, European Union citizens, women and patients under 50 years of age.
Collapse
Affiliation(s)
- Mateja Bulc
- Department of Family Medicine, Medical Faculty of Ljubljana University , Ljubljana , Slovenia
| | | | | |
Collapse
|
39
|
Martins C, Azevedo LF, Ribeiro O, Sá L, Santos P, Couto L, Costa-Pereira A, Hespanhol AP. A population-based nationwide cross-sectional study on preventive health services utilization in Portugal--what services (and frequencies) are deemed necessary by patients? PLoS One 2013; 8:e81256. [PMID: 24278405 PMCID: PMC3836775 DOI: 10.1371/journal.pone.0081256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most of the strategies to induce a more rational use of preventive health services are oriented to the medical side of the doctor-patient relationship. However, the consultation model has changed, and patients now have a more important role in medical consultation. The aim of this study was to assess which healthcare services are deemed necessary, and with what frequency, by adults from the general Portuguese population. METHODS DESIGN Population-based nationwide cross-sectional study Setting: Portuguese population Participants: One thousand Portuguese adults, surveyed by computer-assisted telephone interviewing and selected by a stratified cluster sampling design. MEASUREMENTS Proportions and population prevalence estimates were determined for each healthcare service, taking into account whether respondents considered them necessary, and with what frequency. RESULTS Respondent ages ranged between 18 and 97 years, and 520 of 1000 (52%) respondents were women. Among Portuguese adults, 99.2% (95% confidence interval (CI): 98.5 to 99.6) believe that they should undergo general routine blood and urine tests, to be repeated every 12.0 months on average (95% CI: 11.4 to 12.6); 87.4% (95% CI: 85.3 to 89.3) of the respondents reported having actually performed these tests. Of the 15 services surveyed, 14 were considered periodically necessary by more than 60% of respondents. Among the respondents, 37.7% (95% CI: 34.5 to 41.1) reported using healthcare services by their own initiative. CONCLUSIONS The majority of Portuguese adults believe that they should utilize a great number of healthcare services, on a nearly annual basis; most actually follow this schedule. Our findings indicate a tendency towards the overuse of resources. Adequate patient-oriented strategies regarding the use of medical tests and preventive interventions--with appropriate information and discussion of risks and harms--are urgently needed, and crucial for achieving a more rational use of healthcare services and for preventing the consequences of over-testing.
Collapse
Affiliation(s)
- Carlos Martins
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
- * E-mail:
| | - Luís F. Azevedo
- Centre for Research in Health Technologies and Information Systems (CINTESIS), Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Orquídea Ribeiro
- Centre for Research in Health Technologies and Information Systems (CINTESIS), Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luísa Sá
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| | - Paulo Santos
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| | - Luciana Couto
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| | - Altamiro Costa-Pereira
- Centre for Research in Health Technologies and Information Systems (CINTESIS), Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto P. Hespanhol
- Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal
| |
Collapse
|
40
|
Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences. Int J Clin Pharm 2013; 35:1178-87. [PMID: 24013957 DOI: 10.1007/s11096-013-9845-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies indicate that community pharmacy-based alcohol brief intervention (BI) is feasible. However, few studies report significant reductions in post-BI alcohol consumption and customer experience. Cost-effectiveness has not been previously examined. OBJECTIVES This 5 month study adopted a single group pre- and post-experimental design to: (1) assess uptake of the community pharmacy alcohol BI service; (2) establish post-BI changes in alcohol consumption for hazardous drinkers; (3) report the acceptability of the service to customers who received it; and (4) undertake a preliminary economic evaluation of the service through establishing whether pharmacy-based alcohol BI affected health and social care costs, including lost employment costs, and whether it was cost-effective. SETTING 26 community pharmacies in south London, UK. METHOD Trained pharmacists used the AUDIT-C and a retrospective 7-day Drinking Diary to identify risky drinkers and inform feedback and advice. Harmful drinkers were referred to their general practitioner and/or specialist alcohol services. A confidential service feedback questionnaire was completed by alcohol BI recipients. Baseline and 3-month follow-up telephone interviews were conducted with hazardous and low risk drinkers to assess post-BI alcohol use change and service cost-effectiveness. MAIN OUTCOME MEASURES AUDIT-C, 7-day alcohol unit consumption, drinking days, cost utilisation data. RESULTS Of the 663 eligible customers offered alcohol BI, 141 (21 %) took up the service. Three-quarters of customers were identified as risky drinkers. Follow-up interviews were conducted with 61 hazardous/low risk drinkers (response rate = 58 %). Hazardous drinkers were found to significantly reduce their 7-day alcohol unit consumption and drinking days, but not AUDIT-C scores. The majority of harmful drinkers (91 %, n = 10) who were contactable post-BI had accessed further alcohol related services. Customer feedback was generally positive. Over 75 % of customers would recommend the service to others. The cost of delivering the service was estimated to be £ 134. The difference in service costs pre-BI and post-BI was not statistically significant and remained non-significant when calculated on 500 customers receiving the intervention. CONCLUSION Community pharmacy-based alcohol BI is a low cost service that may not have immediate beneficial impact on health and social service use, but can be effective in reducing drinking in hazardous drinkers.
Collapse
|
41
|
Neuner-Jehle S, Schmid M, Grüninger U. The "Health Coaching" programme: a new patient-centred and visually supported approach for health behaviour change in primary care. BMC FAMILY PRACTICE 2013; 14:100. [PMID: 23865509 PMCID: PMC3750840 DOI: 10.1186/1471-2296-14-100] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Health related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients. METHODS Our new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques-such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors' communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the "Health Coaching" programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients' self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues. RESULTS In total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8-22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the "Health Coaching" programme were consistently high. CONCLUSIONS Our innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.
Collapse
Affiliation(s)
- Stefan Neuner-Jehle
- Institute of General Practice and Health Services Research, University of Zürich, Pestalozzistrasse 24, Zürich 8091, Switzerland
- Swiss College of Primary Care Medicine, Bern, Switzerland
| | - Margareta Schmid
- Institute of Social and Preventive Medicine, University of Zürich, Zürich 8091, Switzerland
| | - Ueli Grüninger
- Institute of Social and Preventive Medicine, University of Zürich, Zürich 8091, Switzerland
- Swiss College of Primary Care Medicine, Bern, Switzerland
| |
Collapse
|
42
|
Murray J, Fenton G, Honey S, Bara AC, Hill KM, House A. A qualitative synthesis of factors influencing maintenance of lifestyle behaviour change in individuals with high cardiovascular risk. BMC Cardiovasc Disord 2013; 13:48. [PMID: 23829636 PMCID: PMC3716917 DOI: 10.1186/1471-2261-13-48] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 06/28/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Management of cardiovascular risk factors includes commitment from patients to adhere to prescribed medications and adopt healthy lifestyles. Unfortunately many fail to take up and maintain the four key healthy behaviours (not smoking, having a balanced diet, limiting alcohol consumption and being more active). Five factors (beliefs, knowledge, transport and other costs, emotions, and friends and family support) are known to predict uptake of lifestyle behaviour change. The key factors influencing maintenance of healthy lifestyles are not known but would be helpful to support the development of relapse prevention programmes for this population. Our review aimed to clarify the main patient perceived factors thought to influence maintenance of changed healthy lifestyles. METHODS We performed a systematic review of qualitative observational studies and applied the principles of content synthesis and thematic analysis to extract reported factors (barriers and facilitators) considered by individuals to be influential in maintaining changed healthy lifestyle behaviours. Factors were then organised into an existing framework of higher order categories which was followed by an analysis of the interrelationships between factors to identify key themes. RESULTS Twenty two studies met our inclusion criteria. Participants reported barriers and facilitators within 13 categories, the majority of which were facilitators. The most commonly reported influences were those relating to social support (whether provided formally or informally), beliefs (about the self or the causes and management of poor health, and the value of maintaining lifestyle behaviours), and other psychological factors (including attitude, thinking and coping styles, and problem solving skills). Physical activity was the most commonly investigated behaviour in four categories, but overall, the main barriers and facilitators were related to a range of behaviours. Through analysis of the interrelationships between factors within categories, 'social support', 'education and knowledge', and 'beliefs and emotions' were all considered key themes. CONCLUSIONS Our review suggests that for the most part, factors that influence lifestyle change are also important for maintaining healthy behaviours. This indicates that addressing these barriers and facilitators within lifestyle support programmes would also be of value in the longer-term.
Collapse
Affiliation(s)
- Jenni Murray
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Grania Fenton
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Stephanie Honey
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Ana Claudia Bara
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Kate Mary Hill
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Allan House
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, The University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK
| |
Collapse
|
43
|
Petek D, Platinovsek R, Klemenc-Ketis Z, Kersnik J. Do family physicians advise younger people on cardiovascular disease prevention? A cross-sectional study from Slovenia. BMC FAMILY PRACTICE 2013; 14:82. [PMID: 23767793 PMCID: PMC3684536 DOI: 10.1186/1471-2296-14-82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/29/2013] [Indexed: 11/26/2022]
Abstract
Background One of the main family practice interventions in the younger healthy population is advice on how to keep or develop a healthy lifestyle. In this study we explored the level of counselling regarding healthy lifestyle by family physicians and the factors associated with it. Methods A cross-sectional study with a random sample of 36 family practices, stratified by size and location. Each practice included up to 40 people aged 18–45 with low/medium risk for cardiovascular disease (CVD). Data were obtained by patient and practice questionnaires and semi-structured interviews. Several predictors on the patient and practice level for received advice in seven areas of CVD prevention were applied in corresponding models using a two-level logistic regression analysis. Results Less than half of the eligible people received advice for the presented risk factors and the majority of them found it useful. Practices with medium patient list-sizes showed consistently higher level of advice in all areas of CVD prevention. Independent predictors for receiving advice on cholesterol management were patients’ higher weight (regression coefficient 0.04, p=0.03), urban location of practice (regression coefficient 0.92, p=0.04), organisation of education by the practice (regression coefficient 0.47, p=0.01) and practice list size (regression coefficient 6.04, p=0.04). Patients who self-assessed their health poorly more frequently received advice on smoking (regression coefficient −0.26, p=0.03). Hypertensive patients received written information more often (regression coefficient 0.66, p=0.04). People with increased weight more often received advice for children’s lifestyle (regression coefficient 0.06, p=0.03). We did not find associations with patient or practice characteristics and advice regarding weight and physical activity. We did not find a common pattern of predictors for advice. Conclusions Counselling for risk diseases such as increased cholesterol is more frequently provided than basic lifestyle counselling. We found some doctors and practice factors associated with counselling behaviour, but the majority has to be explained by further studies.
Collapse
Affiliation(s)
- Davorina Petek
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
| | | | | | | |
Collapse
|
44
|
Truswell AS, Hiddink GJ, Green LW, Roberts R, van Weel C. Practice-based evidence for weight management: alliance between primary care and public health. Fam Pract 2012; 29 Suppl 1:i6-9. [PMID: 22399558 DOI: 10.1093/fampra/cmr058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- A Stewart Truswell
- University of Sydney, Human Nutrition Unit, Biochemistry Building, NSW 2006, Sydney, Australia
| | | | | | | | | |
Collapse
|
45
|
Brotons C, Soriano N, Moral I, Rodríguez-Artalejo F, Banegas JR, Martín-Moreno JM. Intervenciones preventivas en el ámbito de la atención primaria. El ejemplo del PAPPS. Informe SESPAS 2012. GACETA SANITARIA 2012; 26 Suppl 1:151-7. [DOI: 10.1016/j.gaceta.2011.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 10/20/2011] [Accepted: 10/24/2011] [Indexed: 10/14/2022]
|