全科医生在为冠心病患者提供体育活动建议方面的教育与培训需求及要求:德国一项定性研究的结果

General practitioners' educational and training needs and requirements for advising patients with coronary heart disease on physical activity: findings from a qualitative study in Germany.

作者信息

Prinz Alicia, Hoppe Sabrina, Crutzen Rik, Wilm Stefan, Kastaun Sabrina

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, Heinrich-Heine-University Düsseldorf, P.O. Box 101007, Düsseldorf, 40001, Germany.

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

出版信息

BMC Prim Care. 2025 Aug 29;26(1):273. doi: 10.1186/s12875-025-02973-0.

Abstract

BACKGROUND

The World Health Organization and German treatment guidelines emphasise integrating physical activity (PA) advice into primary care of patients with coronary heart disease (CHD). However, this is often inadequately implemented in German general practice. A key barrier may be healthcare professionals' limited knowledge and skills in providing effective and efficient PA guidance - both in general as well as for patients with CHD. International guidelines recommend targeted training for general practitioners (GPs). Understanding GPs' specific educational and training needs is crucial to developing tailored training programmes for improving implementation of advising CHD patients on PA.

METHODS

Between March and June 2023, 12 problem-centred one-on-one interviews and six moderated focus groups (n = 37 participants) with GPs were conducted in-person (total N  = 49 GPs, 37% female, mean age 56 years (36-78 years)). Interview and focus group topic guides were developed and pilot-tested by the multi-professional study team. Transcripts from audio-recorded data were analysed using both deductive and inductive content structuring, within a multi-professional team, with active involvement of GPs. This analysis extends a previous study using the same dataset.  RESULTS: GPs recognise the benefits of PA for CHD patients. Their conceptualisations of PA (e.g., definitions of sport and PA, general statements on PA) vary and the incorporation of PA in everyday activities (e.g., using stairs) to encourage behaviour change is sometimes recommended. GPs identify the following key training needs for providing PA advice to CHD patients: peer exchange and self-reflection, evidence-based knowledge on PA and CHD, practical tools and support materials to facilitate the integration of PA advice into routine practice. These include low-barrier, time-efficient communication techniques, and role-play simulations.  CONCLUSION: This qualitative study provides insights into GPs' needs and preferences regarding the content, didactics, and organisation of training on PA advice. To enhance competence and foster deeper learning, training should combine evidence-based knowledge with practical elements such as simulations and reflective peer exchange. Building on previous findings about GPs' attitudes and experiences, the identified educational needs offer a foundation for developing tailored training to support PA counselling in routine primary CHD care. This training will be implemented and evaluated in a subsequent study.

摘要

背景

世界卫生组织和德国治疗指南强调将体育活动(PA)建议纳入冠心病(CHD)患者的初级保健中。然而,这在德国的普通医疗实践中往往实施得不够充分。一个关键障碍可能是医疗保健专业人员在提供有效且高效的PA指导方面知识和技能有限——无论是总体上还是针对冠心病患者。国际指南建议对全科医生(GPs)进行有针对性的培训。了解全科医生的具体教育和培训需求对于制定量身定制的培训计划以改善向冠心病患者提供PA建议的实施情况至关重要。

方法

2023年3月至6月期间,对全科医生进行了12次以问题为中心的一对一访谈和6次有主持人的焦点小组讨论(n = 37名参与者),均为面对面进行(总共N = 49名全科医生,37%为女性,平均年龄56岁(36 - 78岁))。访谈和焦点小组主题指南由多专业研究团队制定并进行了预测试。使用演绎和归纳内容构建方法,在一个多专业团队中,并在全科医生的积极参与下,对录音数据的文字记录进行了分析。该分析扩展了之前使用相同数据集的一项研究。

结果

全科医生认识到体育活动对冠心病患者的益处。他们对体育活动的概念化理解(例如,运动和体育活动的定义、关于体育活动的一般性陈述)各不相同,有时会建议将体育活动纳入日常活动(例如,使用楼梯)以鼓励行为改变。全科医生确定了向冠心病患者提供体育活动建议的以下关键培训需求:同行交流和自我反思、关于体育活动和冠心病的循证知识、便于将体育活动建议纳入常规实践的实用工具和支持材料。这些包括低门槛、省时的沟通技巧以及角色扮演模拟。

结论

这项定性研究深入了解了全科医生在体育活动建议培训的内容、教学方法和组织方面的需求和偏好。为了提高能力并促进更深入的学习,培训应将循证知识与模拟和反思性同行交流等实践元素相结合。基于之前关于全科医生态度和经验的研究结果,确定的教育需求为开发量身定制的培训提供了基础,以支持在冠心病初级常规护理中进行体育活动咨询。这项培训将在后续研究中实施和评估。

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