Physical activity on prescription (PAP): Costs and consequences of a randomized, controlled trial in primary healthcare

Röme, Andrada; Persson, Ulf; Ekdahl, Charlotte; Gard, Gunvor

doi:10.3109/02813430903438734

Cited by 28 publications

(23 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Five studies originated from the UK (one of them in Scotland), [35][36][37][38][39] four from New Zealand, 40-43 two from Australia, 44 45 and one each from Sweden 46 and the Netherlands. 47 Of the 15 excluded studies, six reported more intensive interventions and/or did not include a face-to-face component (eg, supervised exercise sessions, mail or telephone contact); [48][49][50][51][52][53] four included a combined intervention targeting multiple behaviours (eg, physical activity and diet); 54-57 two were exercise referral schemes (referral to a physical activity specialist or service); 58 59 two did not report a physical activity or cost-effectiveness outcome 60 61 and one study evaluated the cost-effectiveness of a subsidy programme for general practitioner (GP) involvement in physical activity. 62…”

Section: Literature Searchmentioning

confidence: 99%

Are brief interventions to increase physical activity cost-effective? A systematic review

et al. 2015

View full text Add to dashboard Cite

ObjectiveTo determine whether brief interventions promoting physical activity are cost-effective in primary care or community settings.DesignSystematic review of economic evaluations.Methods and data sourcesWe searched MEDLINE, EMBASE, PsycINFO, CINAHL, EconLit, SPORTDiscus, PEDro, the Cochrane library, National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry up to 20 August 2014. Web of Knowledge was used for cross-reference search. We included studies investigating the cost-effectiveness of brief interventions, as defined by National Institute for Health and Care Excellence, promoting physical activity in primary care or the community. Methodological quality was assessed using Drummond's checklist for economic evaluations. Data were extracted from individual studies fulfilling selection criteria using a standardised pro forma. Comparisons of cost-effectiveness and cost-utility ratios were made between studies.ResultsOf 1840 identified publications, 13 studies fulfilled the inclusion criteria describing 14 brief interventions. Studies varied widely in the methods used, such as the perspective of economic analysis, intervention effects and outcome measures. The incremental cost of moving an inactive person to an active state, estimated for eight studies, ranged from £96 to £986. The cost-utility was estimated in nine studies compared with usual care and varied from £57 to £14 002 per quality-adjusted life year; dominant to £6500 per disability-adjusted life year; and £15 873 per life years gained.ConclusionsBrief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care. Given the commonly accepted thresholds, they appear to be cost-effective on the whole, although there is notable variation between studies.

show abstract

Section: Literature Searchmentioning

confidence: 99%

Are brief interventions to increase physical activity cost-effective? A systematic review

et al. 2015

View full text Add to dashboard Cite

show abstract

“…For example, in addition to components described above, counselling techniques such as motivational interviewing (MI) are increasingly incorporated into ERS (Greater Glasgow Health Board, 2004;Hosper et al, 2008;Kallings et al, 2008;Lawton et al, 2009;Sorensen et al, 2008;Jolly et al, 2009;Leijon et al, 2009;Romé et al, 2009), while some emphasise provision of supportive social networks through patient-only classes (Isaacs et al, 2007). In Wales, until 2007, most local health board (LHB) areas operated local ERS.…”

Section: Introductionmentioning

confidence: 98%

Mixed-method process evaluation of the Welsh National Exercise Referral Scheme

et al. 2013

View full text Add to dashboard Cite

Access to this document was granted through an Emerald subscription provided by emerald-srm:368933 [] For AuthorsIf you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -Primary-care referral to community-based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed-method process evaluation exploring how outcomes were achieved. Design/methodology/approach -Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semistructured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme. Findings -NERS offered patients a programme of supervised, group-based discounted exercise. However, motivational interviewing, goal-setting and patient follow-up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient-only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non-car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS. Originality/value -In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed-method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS.

show abstract

“…In Scandinavia as well as in other countries variants for prescribing physical activity exist [6-9]. There is evidence that PAP is a cost-effective method for use in primary care [10,11]. Physicians’ attitudes and their ability to communicate with patients have a significant impact on patient compliance.…”

Section: Introductionmentioning

confidence: 99%

Physical activity on prescription (PAP) from the general practitioner’s perspective – a qualitative study

et al. 2013

View full text Add to dashboard Cite

BackgroundPhysical activity on prescription (PAP) is a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method seems to be sparsely used by general practitioners (GPs) and there is limited information about GPs’ attitudes to counselling using PAP as a tool. The aim of the study was to explore and understand the meaning of prescribing physical activity from the general practitioner’s perspective.MethodsThree focus group interviews were conducted with a purposive sample of 15 Swedish GPs in the south of Sweden. Participants were invited to talk about their experience of using PAP. The interviews were transcribed verbatim, analysed using qualitative content analysis.ResultsThe analysis resulted in four categories: The tradition makes it hard to change attitude, Shared responsibility is necessary, PAP has low status and is regarded with distrust and Lack of procedures and clear guidelines. Traditionally GPs talk with patients about the importance of an increased level of physical activity but they do not prescribe physical activity as a treatment. Physician’s education focuses on the use of pharmaceuticals. The responsibility for patients’ physical activity level is shared with other health professionals, the patient and society. The GPs express reservations about prescribing physical activity. A heavy workload is a source of frustration. PAP is regarded with distrust and considered to be a task of less value and status. Using a prescription to emphasize an increased level is considered to be redundant and the GPs think it should be administered by someone else in the health care system. Scepticism about the result of the method was also expressed.ConclusionsThere is uncertainty about using PAP as a treatment since physicians lack education in non-pharmaceutical methods. The GPs do not regard the written referral as a prioritized task and rather refer to other professionals in the health care system to prescribe PAP. GPs pointed out a need to create routines and arrangements for the method to gain credibility and become everyday practice among GPs.

show abstract

Physical activity on prescription (PAP): Costs and consequences of a randomized, controlled trial in primary healthcare

Cited by 28 publications

References 19 publications

Are brief interventions to increase physical activity cost-effective? A systematic review

Are brief interventions to increase physical activity cost-effective? A systematic review

Mixed-method process evaluation of the Welsh National Exercise Referral Scheme

Physical activity on prescription (PAP) from the general practitioner’s perspective – a qualitative study

Contact Info

Product

Resources

About