Recording Non Communicable Chronic Diseases at Risk Behaviours in General Practice. A qualitative study using the PRECEDE-PROCEED Model.

Abstract

Full, accurate registration of behavioral risk factors in patients is essential for good quality preventive action in General Practice. In addition, the GP's records are useful for epidemiological surveillance of risk behavior and assessment of preventive actions in the community and also for the accurate Case Management in the Continuity of Care perspective. Up to date, very little research has been carried out in Italy in this area. The PRECEDE-PROCEED model was used to analyze data of a semi-structured interview of purposively selected Italian GPs. PRECEDE, the diagnostic component of the model, was used to highlight factors that affected their recording of behavioral risk lifestyles. The PRECEDE framework distinguishes three categories of factors influencing behavior: Predisposing (wanting to do), Reinforcing Factors (rewards for doing) and Enabling Factors (being able to do) 2. The Predisposing Factors were identified as the GPs' positive attitude to writing up structured, systematic records of patient data and the low attitude towards registration of the behavioural risk factors with respect to clinical data. Enabling Factors were: the high load of paperwork; the requirement for quantitative registration of certain factors; the software information structure which limited recording of some risk behaviors. Reinforcing Factors were the GPs perception that patients were reluctant to providing data on their behavior and that they as GPs did not have enough incentives for this work; current local epidemiology selectively focused physicians' attention on recording behaviours related to prevalent diseases. It has been possible to identify ways to improve the quality of GPs records of behavioral risk factors in patients: 1)equipping computer systems with detection procedures to guide GP recordings : 2) training to improve the GP's awareness and attitude and 3) incentives that are not only financial but also linked to professional development.