Understanding exercise referrals in primary care: a qualitative study of General Practitioners and Physiotherapists

Abstract

BackgroundPhysical inactivity is estimated to cost the UK National Health Service over £7.4 billion per year. Healthcare practitioners have a key role in supporting increases in physical activity (PA) levels, including referring to exercise referral schemes. To date, there has been little research into practitioner perspectives on referrals to exercise schemes. ObjectivesTo explore the views and experiences of General Practitioners (GPs) and physiotherapists in relation to factors which influence referral and adherence to exercise referral schemes. Design setting & participantsQualitative study of primary care-based practitioners in Glasgow, UK. MethodsSemi-structured interviews were conducted with 14 practitioners (seven GPs and seven physiotherapists). Interviews were recorded and analysed thematically. ResultsFour themes are presented. Firstly, all people, including healthcare practitioners, bring inherent biases which are influenced by their background, experiences and worldviews to a consultation which impact their approach to PA promotion. Secondly, clinical time pressures are a major barrier to effective PA promotion. Thirdly, patient-led, compassionate care which seeks to fully understand a patient is the most vital component of behaviour change, with suggestions that promoting peer support and the use of personal anecdotes to normalise vulnerabilities might be helpful. Lastly, providing ongoing support for change was felt to be beneficial to PA promotion. This is often accessed through exercise referral schemes and improved by better collaboration between exercise providers and referring practitioners. ConclusionPractitioners believed exercise referrals could be improved with more targeted training in behaviour change facilitation, support for multidisciplinary working, and enhanced communication between the programmes and referrers. Additionally, supporting behaviour change requires time for compassionate care and fully understanding patients’ motivations and beliefs. Lack of time was felt to be the greatest current barrier to effective PA promotion. Contribution of the paper•Previous physical activity promotion research has focussed on overcoming barriers to physical activity.•Few studies have considered the effect of the therapeutic interaction on successful exercise referrals.•In this qualitative study, primary care-based practitioners (GPs and physiotherapists) reported inherent biases which affected referrals, as well as time pressures.•Targeted training, support for multidisciplinary working, and enhanced communication between the programmes and referrers, would improve referrals.