全科医生在心血管疾病预防中对患者激活的态度及障碍：DECADE研究的见解

General practitioners' attitudes and barriers to patient activation in cardiovascular disease prevention: insights from the DECADE study.

作者信息

Gräfe Willy, Tinsel Iris, Börger Maja, Kloppe Thomas, Maun Andy, Riemenschneider Henna

机构信息

Department of General Practice, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.

Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany.

出版信息

BMC Prim Care. 2025 Mar 28;26(1):86. doi: 10.1186/s12875-025-02798-x.

DOI:10.1186/s12875-025-02798-x

PMID:40155816

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11951579/

Abstract

INTRODUCTION

Cardiovascular diseases (CVD) are the most common cause of death in Germany. General practitioners (GPs) have an important role in supporting patients in the prevention of CVD. The DECADE intervention was developed to encourage patients to improve self-management in order to prevent CVD, addressing both GPs and patients. This study focused on GPs attitudes towards patient activation and its relation to the level of activation on their patients, possible barriers according to lifestyle counselling and attitudes towards interprofessional consultations.

METHODS

Questionnaire-based cross-sectional analysis was conducted within the DECADE-cRCT. GPs attitudes to patient activation was measured by using seven items of the Clinician Support for Patient Activation Measure (CS-PAM). The degree of activation of the patients was measured by Patient Activation Measure (PAM13-D). The Barriers and attitudes towards responsibilities for lifestyle counselling were assessed using self-generated items on a 5-point Likert scale. Association between CS-PAM and PAM13-D was analysed using a linear mixed model.

RESULTS

79/82 GPs responded. Mean CS-PAM score of GPs at baseline was 23.00 (range 13-27, max. 28). GPs reported lack of time, funding and uncertainty of the impact as main barriers to the routine implementation of lifestyle counselling. GPs see themselves as primarily responsible for conducting lifestyle counselling, but they also emphasize the importance of interprofessional cooperation. No significant correlations between CS-PAM and PAM13-D were found.

CONCLUSION

GPs perceive patient activation as important. Most GPs reported that they already provide lifestyle counselling as part of their routine practice. Overcoming the identified barriers in GPs lifestyle counselling is a prerequisite for effective and patient-centred consultation on cardiovascular risk factors. The interprofessional collaboration advocated by GPs could relieve the burden on GPs and thus reduce these barriers.

TRIAL REGISTRATIONS

The DECADE-study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00025401; Trial registration date: 2021/06/21) and in the International Clinical Trials Registry Platform (ICTRP): https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00025401 .

摘要

引言

心血管疾病（CVD）是德国最常见的死因。全科医生（GP）在支持患者预防心血管疾病方面发挥着重要作用。“十年”干预措施旨在鼓励患者改善自我管理以预防心血管疾病，涉及全科医生和患者双方。本研究聚焦于全科医生对患者激活的态度及其与患者激活水平的关系、生活方式咨询方面可能存在的障碍以及对跨专业咨询的态度。

方法

在“十年”整群随机对照试验（cRCT）中进行基于问卷的横断面分析。全科医生对患者激活的态度通过使用临床医生对患者激活支持量表（CS - PAM）的七个项目进行测量。患者的激活程度通过患者激活量表（PAM13 - D）进行测量。使用自行编制的5点李克特量表项目评估生活方式咨询的障碍和责任态度。使用线性混合模型分析CS - PAM与PAM13 - D之间的关联。

结果

82名全科医生中有79名做出回应。基线时全科医生的CS - PAM平均得分为23.00（范围13 - 27，最高28）。全科医生报告称，时间不足、资金短缺以及效果不确定性是生活方式咨询常规实施的主要障碍。全科医生认为自己主要负责进行生活方式咨询，但他们也强调跨专业合作的重要性。未发现CS - PAM与PAM13 - D之间存在显著相关性。