Byrne Molly, Campbell Neil C
Department of General Practice, Clinical Science Institute, National University of Ireland, Galway, Ireland.
Eur J Gen Pract. 2003 Dec;9(4):134-40. doi: 10.3109/13814780309160422.
Secondary prevention is an effective strategy for reducing coronary heart disease morbidity and mortality. Secondary prevention in primary care has been shown to be suboptimal. Evidence on approaches to behaviour change, suitable for implementation in primary care, is needed.
To identify approaches to behaviour change in patients with coronary heart disease that are relevant to primary care and compare the views of health professionals in two different healthcare systems (United Kingdom and the Republic of Ireland).
Two nominal groups were conducted in Northeast Scotland and the West of Ireland with expert panels representing core and extended primary care teams. Participants were asked to generate ideas, rank them, and then discuss areas of disagreement before a second round of ranking.
In both groups, there was good consensus on items relating to individual patient assessment (including motivation and understanding), addressing the practitioner's willingness to change, using established principles of behaviour change, and having adequate resources, staff and time. Priorities were, however, different. Emphasis on items relating to resources, staff and organisation was particularly strong in the Irish group; there was more emphasis on approaches to behaviour change in the Scottish group.
When attempting to promote behaviour change and secondary prevention, there are different priorities in different healthcare systems. These should be taken into account in the design of any intervention.
二级预防是降低冠心病发病率和死亡率的有效策略。初级保健中的二级预防已被证明效果欠佳。因此需要有关适合在初级保健中实施的行为改变方法的证据。
确定与初级保健相关的冠心病患者行为改变方法，并比较两个不同医疗体系（英国和爱尔兰共和国）中卫生专业人员的观点。
在苏格兰东北部和爱尔兰西部开展了两个名义群体法，由代表核心和扩展初级保健团队的专家小组参与。要求参与者提出想法、进行排序，然后在第二轮排序前讨论分歧领域。
两组在与个体患者评估（包括动机和理解）、解决从业者改变意愿、运用既定行为改变原则以及拥有充足资源、人员和时间等相关项目上达成了高度共识。然而，优先事项有所不同。爱尔兰组特别强调与资源、人员和组织相关的项目；苏格兰组则更侧重于行为改变方法。
在试图促进行为改变和二级预防时，不同医疗体系有不同的优先事项。在设计任何干预措施时都应考虑到这些因素。
