Hudon Eveline, Beaulieu Marie-Dominique, Roberge Danièle
Department of Family Medicine, University of Montreal, Family Medicine Research Team, Cité de la Santé de Laval, Montreal, Canada.
Fam Pract. 2004 Feb;21(1):11-7. doi: 10.1093/fampra/cmh104.
Surveys conducted in North America and in several European countries show that the preventive activities recommended by some groups of experts are difficult to integrate into medical practice. Interventions to correct this problem have produced mitigated results.
Our aim was to gain a better understanding of the obstacles perceived by a group of family physicians concerning the integration of prevention into their routine practices.
A qualitative design was selected to facilitate the exploration of that topic. Seven focus groups with 35 physicians practising in the Montreal area were conducted. Questions regarding their perception of, and obstacles to, the integration of prevention in their daily work were explored. The text of these interviews was analysed following the content analysis method. Codification of the important themes that were identified was done by two of the researchers.
We met with 35 family physicians in two regions in Montreal, Quebec. The lack of motivation on the part of users and the lack of value placed on continuity of care appear to be the main obstacles in the eyes of the physicians, followed by a lack of financial incentives, work overload, and contradictions among the recommendations. In addition, other obstacles were observed by the researchers: limited intervention strategies on the part of physicians to support behaviour modification among patients, non-recognition of the importance of the organization of practice and inability to acknowledge the obstacles that can be ascribed to their own beliefs.
The family physicians we met identified several barriers to the integration of prevention in their practices. The interventions proposed to date do not address the barriers perceived by the physicians in our study. Continuing medical education activities focus on knowledge, while the difficulties expressed relate more to communication skills coupled with a feeling of powerlessness. The physicians we met with do not seem to consider recall systems and looking at their organization of practice as possible solutions. The physicians seem to 'cave in' under the weight of the responsibilities that have been assigned to them in terms of health promotion. There may be room for proposing a more realistic menu. This study identifies a need for much more specific and concrete training on communication and counselling skills.
在北美和几个欧洲国家进行的调查显示，一些专家小组推荐的预防活动难以融入医疗实践。为纠正这一问题而采取的干预措施取得了一定成效。
我们的目的是更好地了解一组家庭医生在将预防措施融入日常实践中所面临的障碍。
选择定性设计以促进对该主题的探索。在蒙特利尔地区对35名执业家庭医生进行了7次焦点小组访谈。探讨了他们对预防措施融入日常工作的看法和障碍。这些访谈的文本按照内容分析法进行了分析。两名研究人员对所确定的重要主题进行了编码。
我们在魁北克省蒙特利尔的两个地区会见了35名家庭医生。在医生们看来，患者缺乏积极性以及对连续护理缺乏重视似乎是主要障碍，其次是缺乏经济激励、工作负担过重以及建议之间存在矛盾。此外，研究人员还观察到其他障碍：医生支持患者行为改变的干预策略有限、未认识到实践组织的重要性以及无法认识到可归因于自身信念的障碍。
我们会见的家庭医生确定了将预防措施融入其实践中的若干障碍。迄今为止提出的干预措施并未解决我们研究中医生所察觉到的障碍。继续医学教育活动侧重于知识，而所表达的困难更多地与沟通技巧以及无力感有关。我们会见的医生似乎并未将召回系统和审视其实践组织视为可能的解决方案。医生们似乎在促进健康方面所赋予他们的责任压力下“屈服”了。或许有空间提出一份更现实的方案。本研究表明需要针对沟通和咨询技巧进行更具体、更实际的培训。
