通过培训全科医生提供关于身体活动的非常简短的建议来优化慢性缺血性心脏病的治疗（OptiCor）：系统开发和评估复杂干预措施的方案。

Optimising the treatment of chronic ischemic heart disease by training general practitioners to deliver very brief advice on physical activity (OptiCor): protocol of the systematic development and evaluation of a complex intervention.

机构信息

Institute of General Practice (ifam), Patient-Physician-Communication Research Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.

Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

出版信息

BMC Prim Care. 2024 Nov 27;25(1):404. doi: 10.1186/s12875-024-02655-3.

DOI:10.1186/s12875-024-02655-3

PMID:39604870

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11600579/

Abstract

BACKGROUND

Chronic ischemic heart disease (IHD) is one of the leading causes of morbidity and mortality. Physical activity (PA) is an effective secondary preventive strategy in IHD management. The German treatment guideline recommends that general practitioners (GPs) deliver PA advice to patients. This recommendation seems inadequately implemented, often due to GP's insufficient specific training. International guidelines recommend training GPs in how to deliver such advice effectively and efficiently. Evidence is lacking on whether such training can enhance the frequency and quality of PA advice in routine care. The OptiCor project aims to develop and evaluate a GP training in the delivery of very brief PA advice to optimise the treatment of patients with IHD in general practice.

METHODS

OptiCor comprises three study phases according to the Medical Research Council recommendations for developing and evaluating complex interventions. Phase 1 (needs analysis): A nationwide representative household survey will be conducted to collect data on the receipt of GP-delivered PA advice in people with IHD. Qualitative interviews and group discussions with GPs and people with IHD will help to explore, e.g., attitudes, experiences with, and barriers and facilitators of PA advice implementation or reception, respectively. Findings will inform the training development. Phase 2 (pilot): A pragmatic cluster randomised controlled trial (cRCT) on the effectiveness of the developed training on proportions of GP-delivered PA advice during routine care of IHD patients will be piloted. Phase 3 (evaluation): A full pragmatic cRCT will be conducted with patient-reported proportions of GP-delivered PA advice as primary endpoint. Collection of health economic and process-related data will facilitate a potential future broad implementation and health economic evaluation of the training.

DISCUSSION

If the developed training successfully improves proportions and quality of GP delivered PA advice to patients with IHD, it could serve as a low-threshold and sustainable strategy for implementing PA recommendations in the secondary prevention of IHD in routine GP practice.

TRIAL REGISTRATION

Work package (WP) 1, WP5, and WP6 have been prospectively registered at German Clinical Trials Register (WP1: DRKS00031304, 19/06/2023; WP5: DRKS00034641, 10/07/2024; WP6: DRKS00034642; 10/07/2024).

摘要

背景

慢性缺血性心脏病（IHD）是发病率和死亡率的主要原因之一。身体活动（PA）是 IHD 管理的有效二级预防策略。德国治疗指南建议全科医生（GPs）向患者提供 PA 建议。由于 GP 缺乏特定的培训，这一建议似乎没有得到充分实施。国际指南建议培训 GP 如何有效地、高效地提供此类建议。目前尚缺乏证据表明这种培训是否能提高常规护理中 PA 建议的频率和质量。OptiCor 项目旨在开发和评估 GP 培训，以提供非常简短的 PA 建议，从而优化全科医生对 IHD 患者的治疗。

方法

OptiCor 包括根据医学研究委员会制定和评估复杂干预措施的建议进行的三个研究阶段。第 1 阶段（需求分析）：将进行全国范围内具有代表性的家庭调查，以收集 IHD 患者接受 GP 提供的 PA 建议的数据。与 GP 和 IHD 患者进行定性访谈和小组讨论，将有助于分别探讨对 PA 建议实施或接受的态度、经验以及障碍和促进因素。研究结果将为培训的开发提供信息。第 2 阶段（试点）：将对开发的培训对 IHD 患者常规护理中 GP 提供的 PA 建议比例的有效性进行一项实用的集群随机对照试验（cRCT）试点。第 3 阶段（评估）：将对患者报告的 GP 提供的 PA 建议比例作为主要终点进行全面的实用集群随机对照试验（cRCT）。收集卫生经济学和过程相关数据将有助于对培训进行未来的广泛实施和卫生经济学评估。