Putting prevention into practice: qualitative study of factors that inhibit and promote preventive care by general practitioners, with a focus on elderly patients

Abstract

BackgroundGeneral practitioners (GPs) have a key role in providing preventive care, particularly for elderly patients. However, various factors can inhibit or promote the implementation of preventive care. In the present study, we identified and examined factors that inhibit and promote preventive care by German GPs, particularly for elderly patients, and assessed changes in physicians' attitudes toward preventive care throughout their careers.MethodsA qualitative, explorative design was used to identify inhibitors and promoters of preventive care in German general medical practice. A total of 32 GPs in Berlin and Hannover were surveyed. Questions about factors that promote or inhibit implementation of preventive care and changes in physicians' perceptions of promoting and inhibiting factors throughout their careers were identified. Episodic interviews, which encouraged the reporting of anecdotes regarding daily knowledge and experiences, were analyzed using ATLAS/ti. Socio-demographic data of GPs and structural information about their offices were collected using short questionnaires. The factors identified as inhibitory or promoting were classified as being related to patients, physicians, or the healthcare system. The changes in GP attitudes toward preventive care throughout their careers were classified as personal transitions or as social and health policy transitions.ResultsMost of the identified barriers to preventive care were related to patients, such as a lack of motivation for making lifestyle changes and a lack of willingness to pay for preventive interventions. In addition, the healthcare system seemed to inadequately promote preventive care, mainly due to poor reimbursement for preventive care and fragmentation of care. GPs own attitudes and health habits seemed to influence the implementation of preventive care. GPs recognized their own lack of awareness of effective preventive interventions, particularly for elderly patients. GPs were motivated by positive preventive experiences, but often lacked the necessary training to counsel and support their patients.ConclusionsGerman GPs had positive attitudes towards prevention, but the implementation of preventive care was neither systematic nor continuous. Identification and elimination of barriers to preventive care is crucial. Further research is needed to identify effective practice-based approaches to overcome these barriers.

(De)Gendering Older Patients: Exploring Views on Aging and Older Patients in Romanian General Practitioners

“…Present findings lend support to previous literature showing that medical personnel tends to have rather negative images of old age (Walter et al, 2010;Craciun & Flick, 2015;Craciun, 2016). Having a negative image of aging may reflect on how they treat older patients and contribute to the maintenance of negative stereotypes related to old age (Craciun, 2016).…”

“…A positive view of aging means that they see the potential for development and experiencing positive emotions in old age, while negative images of aging mean associating old age with illness and dependency (Levy, 2003;Wurm, Tomasik, & Tesch-Römer, 2010). Previous studies showed that health professionals had more negative images of aging (Walter et al, 2010;Craciun & Flick, 2015;Craciun, 2016). The present study wants to go further and explore whether GPs treat men and women differently Gender may play a role in how GPs relate to aging for several reasons.…”

“…Furthermore, older patients may be the target of double stereotyping and discrimination in terms of both age (Levy, 2003) and gender (Palència, 2014). The present article seeks to add to existing literature on aging representations in medical personnel (Liu, Norman, While, 2013;Walter, Flick, Neuber, Fischer, Hussein, Schwartz, 2010) and experiences of general practitioners with older patients (Craciun & Flick, 2015;Craciun, 2016;Flick, Garms-Homolova, Rönsch, 2012) by exploring how the gender of general practitioners plays a role in their aging representations and how they perceive older women versus older men as patients.…”

Burden of Undetected and Untreated Glaucoma in the United States

“…Similar reasons for nonresponse among the elderly have been documented in other studies 10 and in fact may well represent the physical and psychological barriers to care found in the elderly in the general population. [41][42][43][44] A consequence of nonparticipation in the examination is that the prevalence of undiagnosed glaucoma among nonparticipating elderly, the uninsured, or those below the poverty line is difficult to estimate. Overall prevalence rates of undiagnosed glaucoma may possibly be lower in the elderly population because they were also more likely to self-report glaucoma.…”

“…This is indicated by the similarity between reasons given for nonparticipation in this study's examination and prior research findings of nonparticipation in actual clinical examinations and also in other study settings. 10,[41][42][43][44] Our study uses the most recent data available for a nationally representative assessment of glaucoma status of the US population. Since the study data were released in 2008 and 2010 for the 2005-2006 and 2007-2008 iterations, respectively, significant change has happened in the US healthcare system, including the introduction of the Patient Protection and Affordable Care Act, enacted by the 111th US Congress, with its increased incentives for preventive care.…”