Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Department of Public and Occupational Health, Amsterdam University Medical Centres, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
BMC Med Inform Decis Mak. 2022 Sep 22;22(1):250. doi: 10.1186/s12911-022-01993-5.
There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as 'Exercise is Medicine' (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care.
A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide.
An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients' electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care.
This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation.
有大量证据表明，在医疗保健环境中出于医学原因实施身体活动干预措施。然而，在荷兰的常规医院护理中，目前大多数情况下都没有将身体活动作为治疗方法开具，即“运动就是医学”（Exercise is Medicine，E=M）。为了支持医院临床医生开具 E=M 处方，本研究旨在：（1）开发一种 E=M 工具，用于提供身体活动建议和转诊，以促进医院环境中的 E=M 处方；（2）提供 E=M 决策指南，介绍实施 E=M 的关键决策，为医院护理中的 E=M 处方做准备。
采用混合方法设计，对临床医生、生活方式教练和医院管理人员、患者小组和利益相关者进行问卷调查和面对面访谈，以评估对 E=M 工具和实施 E=M 的关键决策的需求。基于需求评估，开发了一种数字 E=M 工具。关键决策为 E=M 决策指南的制定提供了信息。
为两所学术医院开发了一种用于 E=M 的在线支持工具。基于需求评估，该工具与不同患者的电子病历相链接，并针对两个当地环境（格罗宁根大学医学中心、阿姆斯特丹大学医学中心）进行了定制。E=M 工具由一个工具算法组成，包括使用数字问卷评估的患者特征（年龄、性别、PA、BMI、医疗诊断、改变身体活动的动机以及与医生讨论身体活动的偏好）与标准值相对比。数字 E=M 工具为患者提供了个性化的 E=M 处方，并提供了在医院内外进行当地身体活动干预的转诊选择。还开发了 E=M 决策指南，以支持在医院护理中实施 E=M 处方。
本研究深入了解了 E=M 工具的开发和 E=M 决策，以支持 E=M 处方，并促进针对当地 E=M 治疗方案的定制，使用了强大的利益相关者参与。研究结果可作为其他旨在实施 E=M 的决策支持指南和干预措施的范例。
