Scientific Institute for Quality of Healthcare, IQ healthcare, Radboud University Nijmegen Medical Centre, the Netherlands, P.O. Box 9101, Nijmegen, HB 6500, The Netherlands.
BMC Fam Pract. 2013 Feb 9;14:20. doi: 10.1186/1471-2296-14-20.
The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study.
This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews.
All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients' motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from 'ignorer' to 'nurturer'. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive.
GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.
每年患有慢性病的患者人数都在增加。这在一定程度上是由于不健康的生活方式。然而，荷兰全科医生（GP）和执业护士（PN）开展的（基于证据的）健康促进活动的频率和质量有限。本研究旨在探索荷兰全科医生和执业护士在初级保健中开展的哪些生活方式干预措施，确定可以识别哪些障碍和促进因素，以及与健康促进活动态度相关的主要议题。这些主题领域将确定用于未来更大规模的研究。
这项定性研究包括对 16 名全科医生和 9 名执业护士进行的 25 次半结构化访谈。使用 ATLAS.ti 分析访谈记录的转录本。
所有全科医生和执业护士都说他们会与患者讨论生活方式。除此之外，全科医生和执业护士还会为患者提供咨询服务，并/或将其转介给其他科室。只有少数人表示他们会将患者转介到自己诊所或社区的特定生活方式项目或干预措施。确定了一些障碍和促进因素。主要的障碍包括：患者改变生活方式的动力不足、报销不足、干预措施缺乏有效性证据以及缺乏对社区内健康促进项目的概述。最常提到的促进因素是执业护士的可用性、与其他科室的合作以及自己诊所内干预措施的可用性。就态度而言，确定了六种不同类型的全科医生，反映了与态度相关的主要议题，从“忽视者”到“培育者”不等。与执业护士对健康促进活动的态度相关的主题几乎都是积极的。
全科医生和执业护士都说他们会与患者讨论生活方式问题，但他们在实践中组织的健康促进活动有所不同。确定了阻碍或促进实施的主要议题，包括与全科医生和执业护士的态度相关的议题。
