Narrative review – Barriers and facilitators to promotion of physical activity in primary care

Leese, Callum; Abraham, Kirstin; Smith, Blair H.

doi:10.1002/lim2.81

Cited by 3 publications

(1 citation statement)

References 87 publications

(326 reference statements)

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“…30 While that study identified use of paper referral as their main barrier, our study identified lack of time and training among MAs as main barriers, which is consistent with existing literature. [31][32][33][34] Future areas of improvement may explore ways to further streamline PAVS entry and emphasising EIM documentation by encouraging providers to add the smartphrase to their note templates. Addressing time constraints remains challenging given competing priorities within the broader healthcare structure.…”

Section: Discussionmentioning

confidence: 99%

Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system

Dayao,

Duffy,

Cristiano

et al. 2024

Fam Med Com Health

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ObjectiveExercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician and healthcare staff perspectives using a combination of electronic health record (EHR), survey and interview data.DesignThis study used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM. Data captured from the EHR, including Physical Activity Vital Sign (PAVS) scores, and data collected from qualitative surveys and interviews were used to evaluate the programme’s Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM, which is embedded within PRISM) from provider, staff and patient perspectives.SettingFive primary care clinics within a large academic health system.ParticipantsA total of 24 443 patients from all participating clinics had at least one PAVS score during the study period. A total of 17 clinicians completed surveys, and 4 clinicians, 8 medical assistants and 9 patients completed interviews.ResultsImplementation fidelity metrics varied widely between components and across clinics but were generally consistent over time, indicating a high degree of programme maintenance. Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual. Mean PAVS scores increased from 57.7 (95% CI: 56 to 59.4) to 95.2 (95% CI: 91.6 to 98.8) min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84 (95% CI: 252 to 255.7) to 208.3 (95% CI: 204.2 to 212.4) min per week at 6 months for patients meeting PA guidelines at baseline. After EIM implementation, clinician-estimated time spent discussing PA with patients increased for 35% of providers and stayed the same for 53%.ConclusionOverall, this study established EIM’s feasibility, adoption, implementation and maintenance in routine primary care practice within a large academic health system. From a population health perspective, EIM is a model to emulate to help primary care providers efficiently address healthy lifestyle behaviours in routine primary care visits.

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Section: Discussionmentioning

confidence: 99%

Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system

Dayao,

Duffy,

Cristiano

et al. 2024

Fam Med Com Health

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Introducing lifestyle medicine into family medicine: Theory and applications

Brennan,

Phelps,

McGrady

et al. 2023

Int J Psychiatry Med

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“Lifestyle medicine (LM) is an evidence-based therapeutic intervention delivered by clinicians trained and certified in this specialty to prevent, treat, and often reverse chronic disease”. Eighty percent of the conditions primary care physicians routinely encounter in their offices, e.g., diabetes mellitus, hypertension, COPD, cardiovascular disease, have root causes in poor lifestyle choices, e.g., smoking, insufficient sleep, being sedentary, eating highly processed foods. Lifestyle is the foundation of most chronic disease management guidelines aimed at reducing morbidity and mortality. Studies have shown that changes in lifestyle can be achieved and the changes link almost directly to reduction in risk for chronic illness. Primary care physicians are ideally positioned to incorporate LM into their practices. It is important to recognize and find solutions to the many barriers to implementing LM from the patient, physician, and system level. There is an urgent need to increase opportunities for practicing physicians to increase their knowledge and skills related to LM and include this in medical school and residency curricula. Many resources exist that can provide the necessary training to seasoned physicians and students/residents to become competent in practicing LM and address barriers to implementing LM. LM has the potential to revolutionize clinical practice by placing a greater emphasis on disease prevention and the role of healthy lifestyle behaviors in disease management and remission.

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A movement for movement: an exploratory study of primary healthcare professionals’ perspectives on implementing the Royal College of General Practitioners’ active practice charter initiative

Leese,

Mann,

Al-Zubaidi

et al. 2024

BMC Prim. Care

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Background Regular physical activity (PA) results in extensive physical, psychological, and social benefits. Despite primary care being a key point of influence for PA behaviours in the UK, research indicates poor application of PA interventions in this context. To address this, the Royal College of General Practitioners’ (RCGP) developed and implemented the Active Practice Charter (APC). The aim of the study was to evaluate the perceived impact and acceptability of the APC initiative from the perspective of primary healthcare professionals (PHPs). Methods An online exploratory cross-sectional survey was designed to assess the perceived impact, experiences, and challenges of the APC initiative, from the perspective of PHPs. The survey was distributed by the RCGP via email to 184 registered APC practices across the UK. Results Responses were reviewed from staff (n = 33) from 21 APC practices. Initiatives used by APC practices included: educational programmes, partnerships with PA providers, referral systems, and infrastructure investment. Perceived benefits included: increased awareness about PA, staff cohesion, and improved well-being. However, staff felt the APC had limited effect due to implementation barriers, including: a lack of engagement, time, resources, and funding. Conclusion This is the first evaluation of any nationwide UK-based initiative engaging GP practices in promoting PA. Acknowledging the limitations in response rate, although support exists for the RCGP APC, the evaluation highlights challenges to its implementation. Nonetheless, the wide reach of the RCGP, combined with the cited staff and patient benefits, demonstrates the significant potential of the APC initiative. Given the need to address physical inactivity nationally, further development the APC offers a possible solution, with further research required to overcome the challenges to implementation.

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Narrative review – Barriers and facilitators to promotion of physical activity in primary care

Cited by 3 publications

References 87 publications

Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system

Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system

Introducing lifestyle medicine into family medicine: Theory and applications

A movement for movement: an exploratory study of primary healthcare professionals’ perspectives on implementing the Royal College of General Practitioners’ active practice charter initiative

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