荷兰全科医生对初级保健中联合生活方式干预措施实施的看法：一项定性研究。
GPs' views on the implementation of combined lifestyle interventions in primary care in the Netherlands: a qualitative study.
机构信息
Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Department of Digital Engagement, Cognition and Behavior, Philips Research, Eindhoven, The Netherlands.
出版信息
BMJ Open. 2022 Feb 4;12(2):e056451. doi: 10.1136/bmjopen-2021-056451.
OBJECTIVES
Prevention and lifestyle support are emerging topics in general practice. Healthcare insurance companies reimburse combined lifestyle interventions (CLIs) in the Netherlands since January 2019. CLIs support people with overweight (body mass index, BMI 25-30) or obesity (BMI >30) to reduce weight in peer groups. General practitioners (GPs) are key in the successful implementation of lifestyle interventions in primary care. This study explored GPs' experiences and views on the implementation of CLIs to identify barriers and facilitators to the successful implementation in primary care.
DESIGN
Qualitative study using semistructured interviews. Content analysis consisted of thematic coding and mapping a first stage of predefined and second stage of iterative evolving set of themes.
SETTING
GPs were interviewed in a variety of primary care practices between February and April 2019.
PARTICIPANTS
Fifteen GPs were purposively recruited for semi-structured interviews through snowballing.
RESULTS
Experiences with lifestyle support among GPs ranged from referring patients to other healthcare professionals to taking a proactive role in lifestyle support themselves. Whether or not GPs took an active role in lifestyle support was related to their belief in the effect of lifestyle interventions. Overall, GPs had little experience with CLI in every day practice. Perceived barriers were a lack of availability of CLIs in the region and the potential lack of added value of CLIs on top of existing lifestyle support. Perceived facilitators were coordination of care provision by GP cooperatives and monitoring of the CLI implementation and their results. Reimbursement of CLIs without any costs for participants enabled application.
CONCLUSION
The importance of lifestyle interventions in primary care was acknowledged by all GPs, but they differed in their level of experience with providing lifestyle support and awareness of CLIs. Successful integration of CLIs with primary care requires a solid promotion, a well-coordinated implementation strategy and structural evaluation of long-term effectiveness.
目的
预防和生活方式支持是全科医学中的新兴主题。自 2019 年 1 月以来，荷兰的医疗保健保险公司开始报销综合生活方式干预措施（CLIs）。CLIs 支持超重（身体质量指数，BMI 为 25-30）或肥胖（BMI>30）的人群在同伴小组中减轻体重。全科医生（GP）是在初级保健中成功实施生活方式干预的关键。本研究探讨了 GP 实施 CLI 的经验和观点，以确定在初级保健中成功实施的障碍和促进因素。
设计
使用半结构化访谈的定性研究。内容分析包括主题编码和映射预定义的第一阶段和迭代演变的第二阶段的主题集。
设置
2019 年 2 月至 4 月期间，在各种初级保健诊所采访了 GP。
参与者
通过滚雪球的方式，有针对性地招募了 15 名 GP 进行半结构化访谈。
结果
GP 对生活方式支持的经验范围从将患者转介给其他医疗保健专业人员到积极主动地参与生活方式支持。GP 是否积极参与生活方式支持与他们对生活方式干预效果的信念有关。总体而言，GP 在日常实践中对 CLI 的经验很少。感知障碍是该地区缺乏 CLI 以及 CLI 在现有生活方式支持之外可能缺乏附加值。感知的促进因素是由 GP 合作社协调提供护理和监测 CLI 的实施及其结果。CLI 的报销没有任何参与者的费用使得申请得以进行。
结论
所有 GP 都承认生活方式干预在初级保健中的重要性，但他们在提供生活方式支持的经验水平和对 CLI 的认识程度上存在差异。CLI 与初级保健的成功整合需要强有力的推广、协调一致的实施策略以及对长期效果的结构性评估。
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