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

Abstract

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.

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“…In comparing a written prescription to verbal advice from a medical practitioner, research has it that the written exercise prescription approach was more effective (Marcus et al, 2006). Health providers are aware that PA has been mentioned as first-line treatment in guidelines for several diagnoses yet training in exercise prescription writing is lacking (Dunlop and Murray, 2013;Persson et al, 2013;).This calls for embracing "Exercise is medicine" which is a joint initiative of American College of Sports Medicine (ACSM) in collaboration with American Medical Association that calls for making physical activity assessment and exercise prescription a standard part of disease prevention and treatment.…”

Call to Action: Enhancing 'Exercise is Medicine' from the Perspective of Fitness Professionals

“…Studies have examined how to improve the exercise prescription and referral procedure from the perspective of physicians [9,11,12,16,17], yet EIM believes both physicians and FPs are key members in promoting and implementing the inclusion of exercise in the healthcare system [5]. By conducting a focus groups with personal trainers employed at a campus recreation facility, we are the first pilot study to document information from the perspective of FPs.…”

“…This referral approach can be direct (i.e., physician consults with the patient) or indirect (i.e., physician refers patient to a fitness professional who then consults with the patient). With respect to the former approach, historic and current exercise prescription by physicians is low with research conducted in this area identifying lack of knowledge [7][8][9][10][11][12][13][14] and lack of time [1,12,15] as being the main barriers to exercise prescription by physicians. EIM envisions and encourages a collaborative approach between healthcare providers and FPs to promote physical activity [5,6], yet the perspective of FPs has not been previously explored.…”

Gender perceptions and their impact when referring obese patients for exercise

“…The other half simply gave advice on taking more physical activity (Leemrijse et al, 2015). Research in Sweden found that whilst GPs 7 tended to provide advice to patients on the importance of physical activity, few pro-actively prescribed it (Persson et al, 2013). In addition, Persson et al (2013) found that GPs held reservations about prescribing physical activity, due to the fact that their medical education (i.e.…”

“…Research in Sweden found that whilst GPs 7 tended to provide advice to patients on the importance of physical activity, few pro-actively prescribed it (Persson et al, 2013). In addition, Persson et al (2013) found that GPs held reservations about prescribing physical activity, due to the fact that their medical education (i.e. GP training) had being directed primarily towards the prescription of pharmaceuticals.…”