GPs’ views on the implementation of combined lifestyle interventions in primary care in the Netherlands: a qualitative study

Abstract

ObjectivesPrevention and lifestyle support are emerging topics in general practice. Healthcare insurance companies reimburse combined lifestyle interventions (CLIs) in the Netherlands since January 2019. CLIs support people with overweight (body mass index, BMI 25–30) or obesity (BMI >30) to reduce weight in peer groups. General practitioners (GPs) are key in the successful implementation of lifestyle interventions in primary care. This study explored GPs’ experiences and views on the implementation of CLIs to identify barriers and facilitators to the successful implementation in primary care.DesignQualitative study using semistructured interviews. Content analysis consisted of thematic coding and mapping a first stage of predefined and second stage of iterative evolving set of themes.SettingGPs were interviewed in a variety of primary care practices between February and April 2019.ParticipantsFifteen GPs were purposively recruited for semi-structured interviews through snowballing.ResultsExperiences with lifestyle support among GPs ranged from referring patients to other healthcare professionals to taking a proactive role in lifestyle support themselves. Whether or not GPs took an active role in lifestyle support was related to their belief in the effect of lifestyle interventions. Overall, GPs had little experience with CLI in every day practice. Perceived barriers were a lack of availability of CLIs in the region and the potential lack of added value of CLIs on top of existing lifestyle support. Perceived facilitators were coordination of care provision by GP cooperatives and monitoring of the CLI implementation and their results. Reimbursement of CLIs without any costs for participants enabled application.ConclusionThe importance of lifestyle interventions in primary care was acknowledged by all GPs, but they differed in their level of experience with providing lifestyle support and awareness of CLIs. Successful integration of CLIs with primary care requires a solid promotion, a well-coordinated implementation strategy and structural evaluation of long-term effectiveness.

The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial

“…This study confirms that implementation of lifestyle programmes in primary care still faces large barriers [ 11 , 38 , 39 ]. Our results are in line with in the recently introduced combined lifestyle intervention for people with obesity [ 12 ], which has been covered by basic health insurance since 2019, where the 1-year effects on BMI were limited.…”

“…Higher volumes of usage of physiotherapy and dietician care may indicate a shift towards an improved focus on lifestyle change; however, the difference was not significant (data in Supplementary Material File S3 ). Adaptation by care providers may be influenced by lack of knowledge about the effect of the programme, scientific evidence, availability of lifestyle coaches or the belief that healthcare authorities may be better equipped to provide preventive care [ 39 ]. Furthermore, people who were not motivated to participate in the Healthy Heart programme may demand a more individualised approach to address lifestyle behaviour change [ 12 , 43 ], such as in the trial of Zabaleta-Del-Olmo [ 35 ].…”

Barriers and facilitators of family doctor contract services in caring for disabled older adults in Beijing, China: a mixed methods study

“…By comparing with existing literature, our research finds that the successful implementation of FDCS in other countries has the following commonalities: (1) the development of FDCS is based on community health institutions or platforms, such as Patient-centred Medical Home (PCMH) in USA, 39 40 the family doctor-and-nurse offices in Cuba 41 and family doctors' community private clinic in UK, Germany, Netherlands, French and Canada. [42][43][44][45][46] Although the service model and service content of FDCS is different from the above countries, their health institutions are all over the country, forming the backbone of primary healthcare. (2) Education and training of family doctors is an important prerequisite to ensure the implementation of FDCS.…”

Health promotion in primary care

“…However, due to increasing pressures and the time constraints of primary care, health promotion may feel impossible. Further barriers to health promotion in primary care include GPs’ doubts surrounding the effects of an intervention, low patient motivation and lack of local programmes and resources (Geense et al., 2013; Van der Heiden et al., 2022).…”