scholarly journals A Cross-sectional Analysis of Motivation and Decision Making in Referrals to Lifestyle Interventions by Primary Care General Practitioners: A Call for Guidance

2017 ◽  
Vol 13 (3) ◽  
pp. 301-311 ◽  
Author(s):  
Adrie J. Bouma ◽  
Paul van Wilgen ◽  
Frank Baarveld ◽  
Koen A. P. M. Lemmink ◽  
Ron L. Diercks ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Decision Making ◽  
General Practitioners ◽  
Behavioral Control ◽  
Lifestyle Interventions ◽  
Lifestyle Behaviors ◽  
Allied Health Professionals ◽  
Cross Sectional ◽  
Referral Behavior

Aim. To explore (1) general practitioners’ (GPs’) motivations to refer to lifestyle interventions and to investigate the association between GPs’ own lifestyle behaviors and their referral behavior and (2) patient indicators in the decision-making process of the GPs’ referral to lifestyle interventions. Method. A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs’ referral behaviors were assessed—considering referral and self-reported actual referral—as well as their own lifestyle behaviors (physical activity, dieting, being overweight). Decision making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and case-based referring (vignettes). Results. A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs’ referral behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important, patient indicators in referral to lifestyle interventions were somatic indicators and patients’ motivation for lifestyle interventions. Conclusions. GPs’ motivation and referral behavior might be improved by providing them with tailored resources about evidence-based lifestyle interventions, with support from allied health professionals and with official guidelines for a more objective and systematic screening of patients.

scholarly journals Indirect Health Effects of COVID-19: Unhealthy Lifestyle Behaviors during the Lockdown in the United Arab Emirates

2021 ◽  
Vol 18 (4) ◽  
pp. 1964
Author(s):  
Hadia Radwan ◽  
Mahra Al Kitbi ◽  
Hayder Hasan ◽  
Marwa Al Hilali ◽  
Nada Abbas ◽  
...  
Keyword(s):  
Physical Activity ◽  
United Arab Emirates ◽  
Lifestyle Change ◽  
Change Score ◽  
Lifestyle Changes ◽  
Lifestyle Behaviors ◽  
Negative Consequences ◽  
Unhealthy Lifestyle ◽  
Cross Sectional ◽  
Study Results

Background: Lockdown measures were implemented in many countries to limit the spread of the COVID-19 pandemic. However, such restrictions could precipitate unintended negative consequences on lifestyle behaviors. The main objective of this study was to investigate the prevalence and determinants of unhealthy behavior changes during the COVID-19 lockdown among residents of the United Arab Emirates (UAE). Methods: A cross-sectional web-based survey of adults residing in the UAE was carried out during lockdown (n = 2060). Using a multi-component questionnaire, the collected data included questions regarding the following lifestyle changes: Increased dietary intake, increased weight, decreased physical activity, decreased sleep, and increased smoking. An unhealthy lifestyle change score was calculated based on the number of unhealthy lifestyle changes each participant reported. In addition, sociodemographic and living conditions information was collected. Descriptive statistics as well as simple and multiple linear regression analyses were used to examine the prevalence and determinants of the unhealthy lifestyle changes considered in this study. Results: Among the unhealthy lifestyle changes examined, increased food intake was the most common (31.8%), followed by decreased physical activity (30%), increased weight (29.4%), decreased sleep (20.8%), and increased smoking (21%). In addition to identifying the correlates of each of the aforementioned lifestyle changes, the results of the multiple regression linear analyses revealed the following correlates for the overall unhealthy lifestyle change score: females (β = 0.32, CI: 0.22; 0.42), living in an apartment (β = 0.12, CI: 0.003; 0.23) and being overweight/obese (β = 0.24, CI: 0.15; 0.32) had higher scores, while older adults (>40 years) had lower scores (β = −0.23, CI: −0.34; −0.12). Conclusions: The COVID-19 lockdown has resulted in a high prevalence of unhealthy lifestyle behaviors and practices among UAE residents. The findings of this study provided the evidence base for officials to design interventions targeting high-risk groups and aiming to improve healthy lifestyle factors among residents during the pandemic.

scholarly journals Prevalence and factors associated with chronic wounds in older adults in primary care

2018 ◽  
Vol 52 (0) ◽  
Author(s):  
Chrystiany Plácido de Brito Vieira ◽  
Telma Maria Evangelista de Araújo
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Primary Care ◽  
Chronic Wounds ◽  
Family Income ◽  
Family Health ◽  
Multivariate Logistic Regression Model ◽  
Cross Sectional ◽  
Diabetic Ulcer ◽  
Dietary Restrictions

ABSTRACT Objective: To analyze the prevalence of pressure injuries, diabetic and vasculogenic ulcers and associated factors in older adults attended in primary care. Method: A cross-sectional, analytical study with older adults attended in the Family Health Strategy in a Brazilian municipality. Data collection was performed from January to March 2016 using interviews and evaluations of injuries. The variables were submitted to the multivariate logistic regression model using the odds ratio, with their respective 95% confidence intervals and significance set at <0.05. Results: 339 older adults participated in the study. The mean age was 71.1 years, 67.3% were female, 44% were illiterate, 85% had low family income, 91.7% had underlying diseases, 37.2% had dietary restrictions, and 76.1% did not practice physical activity. The prevalence of pressure injury was 5.0%, diabetic ulcer 3.2%, and vasculogenic ulcer 2.9%. Not working and not regularly practicing physical activity increased the chances of presenting these injuries by 1.5 and 2.3 times, respectively. Being actively mobility and not having dietary restrictions were protective factors for not developing chronic wounds. Conclusion: The prevalence of injuries among older adults was high, and its occurrence is associated with socioeconomic and clinical characteristics.

scholarly journals Exploring general practitioners’ perceptions about the primary care gatekeeper role in Indonesia

2020 ◽  
Author(s):  
Joko Mulyanto ◽  
Yudhi Wibowo ◽  
Dionne S. Kringos
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Work Experience ◽  
Healthcare Delivery ◽  
Care Facility ◽  
Personal Factors ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
And Performance

Abstract Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors.Results GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.

scholarly journals Collaboration amongst general practitioners and gynaecologists working in primary health care in Germany: a cross-sectional study

2021 ◽  
Vol 22 ◽  
Author(s):  
Barbara Trusch ◽  
Christoph Heintze ◽  
Elena Petelos ◽  
Lorena Dini
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Interprofessional Collaboration ◽  
Cross Sectional Study ◽  
Postal Survey ◽  
Sectional Study ◽  
Healthcare Provision ◽  
Cross Sectional ◽  
Federal States ◽  
Key Competencies

Abstract Aim: This cross-sectional study is the first one to explore the collaboration of the influencing factors thereof amongst general practitioners (GPs) and gynaecologists (Gyns) working in primary care in urban and rural settings in Germany. Background: The number of women aged ≥ 50 years is predicted to increase in the next years in Germany. This coincides with the ageing of primary care specialists providing outpatient care. Whereas delegation of tasks to nurses as a form of interprofessional collaboration has been the target of recent studies, there is no data regarding collaboration amongst physicians in different specialisations working in primary care. We explored collaboration amongst GPs and Gyn regarding the healthcare provision to women aged ≥ 50 years. Methods: A quantitative postal survey was administered to GPs and Gyns in three federal states in Germany, focusing on care provision to women aged ≥ 50 years. A total of 4545 physicians, comprising 3514 GPs (67% of the total GP population) randomly selected, and all 1031 Gyns practicing in these states received the postal survey in March 2018. A single reminder was sent in April 2018 with data collection ending in June 2018. Multiple logistic regressions were performed for collaboration, adjusted by age and sex, alongside descriptive methods. Findings: The overall response rate was 31% (1389 respondents): 861 GPs (25%) and 528 Gyns (51%), with the mean respondent age being 54.4 years. Seventy-two per cent were female. Key competencies of collaboration are associated with working in rural federal states and with network participation. Physicians from rural states [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.2, 1.9] and physicians in networks (OR = 3.0, CI = 2.3, 3.9) were more satisfied with collaboration. Collaboration to deliver services for women aged ≥ 50 years is more systematic amongst GPs and Gyns who are members of a network; increased networking could improve collaboration, and ultimately, outcomes too.

scholarly journals Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

2021 ◽  
Vol 22 ◽  
Author(s):  
Peter P. Groenewegen ◽  
Wienke G. W. Boerma ◽  
Peter Spreeuwenberg ◽  
Bohumil Seifert ◽  
Willemijn Schäfer ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Professional Training ◽  
Institutional Development ◽  
Task Shifting ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Independent Variables ◽  
Nurse Prescribing ◽  
Number Of Patients

Abstract Aim: To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable ‘task shifting’ is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. Findings: Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.

scholarly journals Provider advice on physical activity and nutrition in twin pregnancies: a cross-sectional electronic survey

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kara M. Whitaker ◽  
Meghan Baruth ◽  
Rebecca A. Schlaff ◽  
Hailee Talbot ◽  
Christopher P. Connolly ◽  
...  
Keyword(s):  
Physical Activity ◽  
The United States ◽  
Moderate Intensity ◽  
Lifestyle Behaviors ◽  
Care Providers ◽  
Cross Sectional ◽  
Activity Restriction ◽  
Electronic Survey ◽  
Provider Advice ◽  
Twin Pregnancies

Abstract Background Health care providers should counsel pregnant patients on physical activity and nutrition to improve pregnancy outcomes. However, little is known about provider advice on these lifestyle behaviors among women pregnant with twins, a growing population at high risk for pregnancy complications. We examined the prevalence and content of provider advice on physical activity and nutrition among women pregnant with twins. Methods A cross-sectional electronic survey was administered to 276 women who delivered twins in the past 3 years and received prenatal care in the United States. The proportion of women reporting provider advice on physical activity and nutrition during prenatal visits (yes/no) was assessed and open-ended questions examined the content of provider advice. Bivariate differences in participant characteristics, stratified by provider advice on physical activity and nutrition (yes/no), were assessed. Responses from open-ended questions were examined using a content analysis approach to identify commonly reported advice on physical activity and nutrition. Results Approximately 75 and 63% of women reported provider advice on physical activity and nutrition, respectively, during their twin pregnancy. Women who recalled advice on physical activity most commonly reported recommendations to walk at a light to moderate intensity level. However, few women reported physical activity recommendations consistent with current guidelines, and approximately 55% of women reported provider advice to limit or restrict activity during their pregnancy, including bedrest. Nutrition advice was focused on eating a healthy, balanced diet and increasing protein intake. More women reported self-initiating the conversation on physical activity with their provider (40%) compared to nutrition (21%). Despite limited advice, 70% of women reported being satisfied or very satisfied with the information they received from their provider on physical activity or nutrition. Conclusions The majority of women reported provider advice on physical activity and nutrition during their twin pregnancies. However, advice was limited in detail, and physical activity levels were commonly restricted, despite the lack of evidence that activity restriction is beneficial during pregnancy. More research is needed to determine the optimal physical activity and dietary patterns in twin pregnancies to facilitate clear and consistent provider counseling on these lifestyle behaviors.

scholarly journals General practitioners referring patients to specialists in tertiary healthcare: a qualitative study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Konstantinos Tzartzas ◽  
Pierre-Nicolas Oberhauser ◽  
Régis Marion-Veyron ◽  
Céline Bourquin ◽  
Nicolas Senn ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
General Practitioners ◽  
Care Center ◽  
Decision Making Process ◽  
Primary Care Center ◽  
Feedback Group ◽  
Clear Cut ◽  
Tertiary Healthcare ◽  
Complex Cases

Abstract Background There is a large and unexplained variation in referral rates to specialists by general practitioners, which calls for investigations regarding general practitioners’ perceptions and expectations during the referral process. Our objective was to describe the decision-making process underlying referral of patients to specialists by general practitioners working in a university outpatient primary care center. Methods Two focus groups were conducted among general practitioners (10 residents and 8 chief residents) working in the Center for Primary Care and Public Health (Unisanté) of the University of Lausanne, in Switzerland. Focus group data were analyzed with thematic content analysis. A feedback group of general practitioners validated the results. Results Participating general practitioners distinguished two kinds of situations regarding referral: a) “clear-cut situations”, in which the decision to refer or not seems obvious and b) “complex cases”, in which they hesitate to refer or not. Regarding the “complex cases”, they reported various types of concerns: a) about the treatment, b) about the patient and the doctor-patient relationship and c) about themselves. General practitioners evoked numerous reasons for referring, including non-medical factors such as influencing patients’ emotions, earning specialists’ esteem or sharing responsibility. They also explained that they seek validation by colleagues and postpone referral so as to relieve some of the decision-related distress. Conclusions General practitioners’ referral of patients to specialists cannot be explained in biomedical terms only. It seems necessary to take into account the fact that referral is a sensitive topic for general practitioners, involving emotionally charged interactions and relationships with patients, colleagues, specialists and supervisors. The decision to refer or not is influenced by multiple contextual, personal and clinical factors that dynamically interact and shape the decision-making process.

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