Abstract
BackgroundDespite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice.This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC.MethodsA prospective audit of assessment and intervention for lifestyle risk factors was undertaken by PHC nurses and allied health providers (n = 57) for all patients seen (n = 732) over a two week period. Providers completed a survey to assess key attitudes related to addressing lifestyle issues. Multi-level logistic regression analysis of patient audit records was undertaken. Associations between variables from both data sources were examined, together with the variance explained by patient and consultation (level 1) and provider (level 2) factors.ResultsThere was significant variance between providers in the assessment and intervention for lifestyle risk factors. The consultation type and reason for the visit were the most important in explaining the variation in assessment practices, however these factors along with patient and provider variables accounted for less than 20% of the variance. In contrast, multi-level models showed that provider factors were most important in explaining the variance in intervention practices, in particular, the location of the team in which providers worked (urban or rural) and provider perceptions of their effectiveness and accessibility of support services. After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention. Together, measured patient consultation and provider variables accounted for most (80%) of the variation in intervention practices between providers.ConclusionThe findings highlight the importance of provider factors such as beliefs and attitudes, team location and work context in understanding variations in the provision of lifestyle intervention in PHC. Further studies of this type are required to identify variables that improve the proportion of variance explained in assessment practices.
Highlights
Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice
This study reported that approximately 20% of the variance in cardiovascular prevention activities between general practitioners (GP) was attributable to patient level factors and 38% to GP level factors such as workload and practice location [32]
After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention
Summary
Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC. A number of studies have explored factors influencing the management of lifestyle issues in PHC, mainly through the cross sectional analysis of factors associated with self reported practice in provider surveys These studies have reported associations between a range of provider and organisational factors and the management of behavioural risk factors including provider characteristics (age, gender, provider type) [9,10,11], beliefs and attitudes (in particular confidence to intervene and perceived effectiveness) [12,13,14,15,16], work context (eg size or location of practice), and system barriers such as lack of time and financial incentives [10,14,17]. These studies have reported differences in recall or observation of advice provision for lifestyle risk factors according to the patients' gender [18,19,20,21,22,23], age [1821,24], socio-economic status [18,20,22,24,25], number of existing conditions and risk factors [19,20,26] and primary care attendance rates [20]
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