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初级保健中对肥胖患者的态度、行为和策略:德国全科医生的定性访谈研究。

Attitudes, behaviours and strategies towards obesity patients in primary care: A qualitative interview study with general practitioners in Germany.

机构信息

Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany.

出版信息

Eur J Gen Pract. 2021 Dec;27(1):27-34. doi: 10.1080/13814788.2021.1898582.

Abstract

BACKGROUND

Obesity poses severe challenges for the health care system. GPs are in an advantageous position to contribute to preventing obesity by diagnosing patients and initiating treatment. Sporadic studies have shown that attitudes towards obesity management in primary care can have a major influence on treating patients successfully.

OBJECTIVES

The study focuses on attitudes and behavioural patterns towards obesity patients, willingness to provide care, approaches and strategies, and the challenges experienced.

METHODS

After developing the interview guides based on a literature review, 36 GPs in North Rhine-Westphalia and Saarland, Germany, were interviewed between November 2019 and March 2020. Using qualitative typing according to Kluge, different prototypes of GPs were formed. The dimensions of the interview guides were used for deriving the prototypes.

RESULTS

GPs were categorised into four types depending on how they saw themselves and their role in treating patients. The first type (the resigned) was conspicuous through its negative attitude towards obesity management and a lack of willingness to provide care. The second type (the instructors) emphasised the value of active exercise, diet and health promotion, while the third type (the motivators) saw psychosocial support and motivation as a key element in helping patients. In contrast, type four (the educators) focussed primarily on early prevention through patient education.

CONCLUSION

Depending on which (proto-)type a patient visits, different focuses and strategies are pursued for obesity management and doctor-patient communication. This results in different perspectives and chances of success about therapeutic measures.

摘要

背景

肥胖对医疗保健系统构成严重挑战。全科医生通过诊断患者和启动治疗,处于预防肥胖的有利地位。零星研究表明,初级保健中对肥胖管理的态度对成功治疗患者有重大影响。

目的

本研究重点关注全科医生对肥胖患者的态度和行为模式、提供护理的意愿、方法和策略以及所面临的挑战。

方法

在基于文献综述制定访谈指南后,于 2019 年 11 月至 2020 年 3 月在德国北莱茵-威斯特法伦州和萨尔州对 36 名全科医生进行了访谈。根据 Kluge 的定性分类,形成了不同类型的全科医生原型。访谈指南的维度用于得出原型。

结果

根据他们对自己和治疗患者角色的看法,将全科医生分为四种类型。第一种类型(顺从型)表现出对肥胖管理的消极态度和缺乏提供护理的意愿。第二种类型(教导型)强调积极运动、饮食和健康促进的价值,而第三种类型(激励型)则将社会心理支持和激励视为帮助患者的关键要素。相比之下,第四种类型(教育型)主要侧重于通过患者教育进行早期预防。

结论

根据患者就诊的(原型)类型,肥胖管理和医患沟通会采用不同的重点和策略。这导致了对治疗措施的不同看法和成功机会。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6567/7993392/a328bbfd994e/IGEN_A_1898582_F0001_C.jpg

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