Schütze Heike, Rix Elizabeth F, Laws Rachel A, Passey Megan, Fanaian Mahnaz, Harris Mark F
University of New South Wales, Sydney, Australia.
Aust J Prim Health. 2012;18(2):129-37. doi: 10.1071/PY10106.
Vascular disease is a leading cause of death and disability. While it is preventable, little is known about the feasibility or acceptability of implementing interventions to prevent vascular disease in Australian primary health care. We conducted a cluster randomised controlled trial assessing prevention of vascular disease in patients aged 40-65 by providing a lifestyle modification program in general practice. Interviews with 13 general practices in the intervention arm of this trial examined their views on implementing the lifestyle modification program in general practice settings. Qualitative study, involving thematic analysis of semi-structured interviews with 11 general practitioners, four practice nurses and five allied health providers between October 2009 and April 2010. Providing brief lifestyle intervention fitted well with routine health-check consultations; however, acceptance and referral to the program was dependent on the level of facilitation provided by program coordinators. Respondents reported that patients engaged with the advice and strategies provided in the program, which helped them make lifestyle changes. Practice nurse involvement was important to sustaining implementation in general practice, while the lack of referral services for people at risk of developing vascular disease threatens maintenance of lifestyle changes as few respondents thought patients would continue lifestyle changes without long-term follow up. Lifestyle modification programs to prevent vascular disease are feasible in general practice but must be provided in a flexible format, such as being offered out of hours to facilitate uptake, with ongoing support and follow up to assist maintenance. The newly formed Medicare Locals may have an important role in facilitating lifestyle modification programs for this target group.
血管疾病是导致死亡和残疾的主要原因。虽然它是可预防的，但对于在澳大利亚初级卫生保健中实施预防血管疾病干预措施的可行性或可接受性，人们知之甚少。我们进行了一项整群随机对照试验，通过在全科医疗中提供生活方式改善项目，评估对40 - 65岁患者血管疾病的预防效果。对该试验干预组的13家全科医疗诊所进行访谈，了解他们对在全科医疗环境中实施生活方式改善项目的看法。这是一项定性研究，对2009年10月至2010年4月期间11名全科医生、4名执业护士和5名专职医疗服务提供者进行半结构化访谈，并进行主题分析。提供简短的生活方式干预与常规健康检查咨询相契合；然而，该项目的接受度和转诊情况取决于项目协调员提供的协助程度。受访者表示，患者采纳了项目中提供的建议和策略，这有助于他们改变生活方式。执业护士的参与对于在全科医疗中持续实施该项目很重要，而缺乏针对有患血管疾病风险人群的转诊服务，威胁到生活方式改变的维持，因为很少有受访者认为患者在没有长期随访的情况下会继续保持生活方式的改变。在全科医疗中，预防血管疾病的生活方式改善项目是可行的，但必须以灵活的形式提供，例如在非工作时间提供以促进参与，并提供持续的支持和随访以协助维持。新成立的医疗保险地区机构可能在推动针对这一目标群体的生活方式改善项目方面发挥重要作用。
