Primary prevention in general practice – views of German general practitioners: a mixed-methods study

Abstract

BackgroundPolicy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention.MethodsMixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention.ResultsMost respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions.ConclusionsThe mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.

Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services

“…Similarly, previous studies of support by clinical staff for the provision of smoking cessation care in inpatient and community mental health services (Robson, Haddad, Gray, & Gournay, 2013;Wye et al, 2010b), GPs (Holmberg et al, 2014), and NGOs (Bryant et al, 2012). A lesser proportion of participants expected smoking cessation care to be provided by NGOs, a finding that may reflect such services not having a direct focus on the provision of health-related care (Housego & O'Brien, 2012).…”

“…Despite the existence of guidelines, the literature indicates that smoking cessation care is not routinely provided to smokers with a mental illness in inpatient (Prochaska et al, 2004;Wye et al, 2010a) or community (Anderson et al, 2013;Bartlem et al, 2015;Bartlem et al, 2014) mental health services and smoking cessation supports such as Quitline referral and nicotine replacement therapy are not routinely provided (Anderson et al, 2013;Bartlem et al, 2015;Bartlem et al, 2014). In GP, suboptimal smoking cessation care has been reported to be provided to both general and mental health patients (Holmberg et al, 2014;Lord et al, 2010;McKayBrown et al, 2008).…”

Long-term effect of a low-intensity smoking intervention embedded in an adherence program for patients with hypercholesterolemia: Randomized controlled trial

“…They potentially counseled patients on risk factors including smoking according to European recommendations for the prevention of coronary heart Table 2 Intervention effect on smoking during follow-up (Germany, 2002(Germany, -2007 disease (Anon, 1998). In Germany, the majority of the general practitioners usually address smoking cessation in patients who smoke (Holmberg et al, 2014). In addition, study participation per se may have an effect on outcomes, independently of study arm allocation, only by receiving attention due to repeated assessments (Berthelot et al, 2011;McCarney et al, 2007).…”

Primärprävention in der Allgemeinarztpraxis: Eine Befragung

“…Zwischen November 2010 und Februar 2011 führten wir eine postalische Befragung aller niedergelassenen Allgemeinärzte in Berlin (n = 1 168) durch. Der 2-seitige Fragebogen basierte zum Teil auf bestehenden Fragebögen [18,19] und wurde mittels kognitiver Interviews und einem Prä-Test mit Allgemeinärzten überprüft und finalisiert [20]. Der Fragebogen erfasste a) ob und auf welche Präventionsprogramme die Ärzte ihre Patienten hinweisen, b) ob die Ärzte die Möglichkeit der teilweisen Kostenrückerstattung der Präventionsprogramme nach §20 durch die GKV für die Patienten kennen und beim Empfehlen der Programme darauf achten und c) ob die Ärzte selber Präventionsprogramme nach §20 oder IGeL-Präventionsleistungen anbieten und falls ja, welcher Art (offene Frage).…”

“…Das Studiendesign und die Datenerhebung wurde in Holmberg et al [20] beschrieben. Dort wurde auch zur Beurteilung der Repräsentativität der Teilnehmer die Studienpopulation mit der Grundgesamtheit aller niedergelassener Allgemeinärzte in Berlin verglichen.…”