Counselling In General Practice Research Articles

Physical activity counselling in general practice

Zusammenfassung Hintergrund Regelmäßige Bewegung ist wirksam in der Primär- und Sekundärprävention nicht übertragbarer Krankheiten. Allerdings bewegen sich die meisten Menschen deutlich zu wenig. Fast alle aktuellen Behandlungsleitlinien empfehlen, Patient:innen zu Bewegung zu beraten und zu motivieren. Wie kann solche Beratung wirksam und effizient in der Hausarztpraxis umgesetzt werden? Ziele der Arbeit Übersichtliche Darstellung der Relevanz des Themas, von Studien und Empfehlungen zur Umsetzung und Wirksamkeit hausärztlicher Beratung zu Bewegung sowie Ziehen von Schlussfolgerungen für die hausärztliche Praxis und Forschung. Material und Methoden Nichtsystematische Zusammenfassung wissenschaftlicher und nichtwissenschaftlicher Literatur zum Thema. Ergebnisse Hausärztliche Beratung zu Bewegung kann nachweislich einen Anstoß geben, um Patient:innen zur Bewegungssteigerung zu motivieren. Sie kann als Kurzberatung durchgeführt werden und ist v. a. wirksam, wenn sie ein Unterstützungsangebot, konkrete und für die Patient:innen umsetzbare Empfehlungen sowie fokussierte Folgekontakte enthält. Studien zeigen oft strukturelle Barrieren auf, die der Umsetzung entsprechender Beratung entgegenstehen. Diese Barrieren stellen für die hausärztliche Versorgung relevante Forschungsthemen dar. Schlussfolgerung Mit dem Angebot kurzer Beratung zu Bewegung können Hausärzt:innen einen wichtigen Beitrag zur Reduktion der Krankheitslast durch chronische Krankheiten leisten. Daher sollten wirksame Strategien zur Stärkung der hausärztlich initiierten Bewegungsförderung entwickelt werden. Relevante Ansatzpunkte sind neben der Verbesserung der strukturellen Voraussetzungen auch der Ausbau praktischer Fertigkeiten und des Vertrauens in wirksame Bewegungsberatung seitens der Ärzt:innen.

Validation of Cardiovascular Risk Prediction by the Arriba Instrument.

It is recommended in cardiovascular prevention guidelines that treatment should be based on overall cardiovascular risk. The arriba instrument has been widely used for this purpose in Germany. The aim of this study is to validate risk prediction by arriba with the aid of morbidity and mortality data from the population- based Study of Health in Pomerania. In a longitudinal analysis, the arriba instrument was used to calculate the 10-year overall cardiovascular risk at baseline for subjects who had not sustained any prior cardiovascular event. Cardiovascular event rates were determined from follow-up data, and discrimination and calibration measures for the risk determination algorithm were calculated. Data from 1973 subjects (mean age 51 ± 13 years, 48% men) were included in the analysis. After a median follow-up of 10.9 years, cardiovascular events had occurred in 196 subjects, or 9.8%. The ratio of predicted to observed event rate was 0.8 (95% confidence interval: [0.5; 1.1]), 1.3 [1.0; 1.8], and 1.1 [0.8; 1.4] for subjects at low, intermediate, and high cardiovascular risk, respectively. Arriba underestimated cardiovascular event rates in women and overestimated them in persons aged 30-44 and 45-59. The area under curve was 0.84 [95% CI 0.81; 0.86]. The discrimination scores of the arriba instrument resemble those of SCORE-Germany and PROCAM, but a better adjustment to the target population would be desirable. The results support the recommendation of the German Guideline for Cardiovascular Risk Counseling in General Practice for the use of the arriba instrument. An unresolved problem is the failure to consider intervention effects, resulting in an overall mild overestimation of risk.

A pedometer-based walking intervention with and without email counseling in general practice: a pilot randomized controlled trial

BackgroundGeneral practitioners play a fundamental role in combatting the current epidemic of physical inactivity, and pedometer-based walking interventions are able to increase physical activity levels of their patients. Supplementing these interventions with email counseling driven by feedback from the pedometer has the potential to further improve their effectiveness but it has to be yet confirmed in clinical trials. Therefore, the aim of our pilot randomized controlled trial is to evaluate the feasibility and potential efficacy of future trials designed to assess the additional benefit of email counseling added to a pedometer-based intervention in a primary care setting.MethodsPhysically inactive patients were opportunistically recruited from four general practices and randomized to a 12-week pedometer-based intervention with or without email counseling. To explore the feasibility of future trials, we assessed the speed and efficiency of recruitment, adherence to wearing the pedometer, and engagement with email counseling. To evaluate the potential efficacy, daily step-count was the primary outcome and blood pressure, waist and hip circumference, and body mass were the secondary outcomes. Additionally, we conducted a qualitative analysis of structured interviews with the participating general practitioners.ResultsThe opportunistic recruitment has been shown to be feasible and acceptable, but relatively slow and inefficient; moreover, general practitioners selectively recruited overweight and obese patients. Patients manifested high adherence, wearing the pedometer on 83% (± 20) of days. All patients from the counseling group actively participated in email communication and responded to 46% (± 22) of the emails they received. Both groups significantly increased their daily step-count (pedometer-plus-email, + 2119, p = 0.002; pedometer-alone, + 1336, p = 0.03), but the difference between groups was not significant (p = 0.18). When analyzing both groups combined, there was a significant decrease in body mass (− 0.68 kg, p = 0.04), waist circumference (− 1.73 cm, p = 0.03), and systolic blood pressure (− 3.48 mmHg, p = 0.045).ConclusionsThis study demonstrates that adding email counseling to a pedometer-based intervention in a primary care setting is feasible and might have the potential to increase the efficacy of such an intervention in increasing physical activity levels.Trial registrationThe trial was retrospectively registered at ClinicalTrials.gov (ID: NCT03135561, date: April 26, 2017).

Self-Assessment of competence during post-graduate training in general medicine: A preliminary study to develop a portfolio for further education.

Awareness of one’s own strengths and weaknesses is a key qualification for the specialist physician. We examined how physicians undergoing specialist training in general medicine rate themselves in different areas.For this purpose, 139 participants receiving post-graduate training in general practice offered by the Medical Association of Westfalen-Lippe assessed themselves regarding their subjective confidence in 20 core competencies and 47 situations involving patient counseling in general practice. Their self-assessments were recorded on a five-point Likert scale. The study questions addressed acceptance and practicability of self-assessment, mean values, reliability, stratification and plausibility of the results in group comparison.On average participants rated their subjective confidence with 3.4 out of 5 points. The results are self-consistent (Cronbach’s alpha >0.8), although there are considerable differences among competencies and among participants. The latter can be explained partly by biographical data, which supports the plausibility of the data.Participants stated that regularly gathering data on subjective learning needs and the discussion of these needs with mentors and trainers contributes to improving their specialist training.Elements for self-assessment are suitable for integration into a postgraduate training portfolio. These should be supplemented by formative assessment procedures.

The effects of the counseling on life style of menopausal women and

The effects of the counseling on life style of menopausal women and

Smoking cessation counselling in general practice for COPD smokers: determinants for general practitioners' compliance with a treatment protocol

For chronic obstructive pulmonary disease (COPD), smoking cessation is the main treatment goal. We examined compliance with a smoking cessation treatment protocol for COPD smokers by 47 general practitioners (GPs). Baseline and evaluation questionnaires were completed, and 34 of the GPs then took part in a semi-structured telephone interview. The main outcome measure was restarting of the protocol when a patient had relapsed during a quit attempt. Attitudes, social influences and perceived self-efficacy were assessed to understand compliance or non-compliance with the treatment protocol. The rates of self-reported compliance with seven out of nine aspects of the protocol were high (76% on average). Fifty-three per cent of the GPs restarted the treatment protocol following patient's relapse. A substantial percentage of the GPs reported being seriously disappointed by the effectiveness of the treatment protocol. A change of practice personnel or having unmotivated personnel hindered compliance with the treatment protocol. The majority of the GPs planned to continue using the protocol. Given that negative attitudes, a perceived lack of social support and lack of counselling self-confidence were associated with lower protocol compliance, less confident GPs and GPs who have negative attitudes towards the provision of smoking cessation support should delegate the counselling or refer their patients. It is also concluded that GPs should be given more realistic expectations about smoking cessation and, rather than drop support efforts when they experience a lack of time or lack of confidence for counselling smoking cessation, delegate these tasks to practice assistants or other personnel.

Patients' experiences with lifestyle counselling in general practice: A qualitative study

Objective. (1) To elucidate the relevance of Habermas's theory as a practical deliberation procedure in lifestyle counselling in general practice, using a patient perspective. (2) To search for topics which patients consider of significance in such consultations. Design. Qualitative observation and interview study. Setting. General practice. Subjects. A total of 12 patients were interviewed after lifestyle consultations with their GPs. Main outcome measures. How the patients perceived the counselling, how it affected them, and what they wanted from their GP in follow-up consultations. Results. The GP should be a source of medical knowledge and a caretaker, but also actively discuss contextual reasons for lifestyle choices, and be a reflective partner exploring values and norms. The patients wanted their GP to acknowledge emotions and to direct the dialogue towards common ground where advice was adjusted to the concrete life situation. A good, personal doctor–patient relationship created motivation and obligation to change, and allowed counselling to be interpreted as care. Conclusion. The findings underscore the necessity of a patient-centred approach in lifestyle counselling and support the relevance of Habermas's theory as practical guidance for deliberation. Implications. The findings suggest that GPs should trust the long-term effects of investing in a good relationship and personalized care in lifestyle consultations. The study should incite the GP to act as an encouraging informer, an explorer of everyday life and reasons for behaviour, a reflective partner, and a caretaker, adjusting medical advice to patients' identity, context, and values.

Lifestyle, health and the ethics of good living. Health behaviour counselling in general practice

Objective To present theory that illustrates the relevance of ethics for lifestyle counselling in patient-centred general practice, and to illustrate the theory by a qualitative study exploring how doctors may obstruct or enhance the possibilities for ethical dialogue. Methods The theoretical part is based on theory of common morality and Habermas’ communication theory. The empirical study consists of 12 consultations concerning lifestyle changes, followed by interviews of doctors and patients. Analysis: Identification of two contrasting consultations holding much and little ethical dialogue, “translation” into speech acts, and interpretation of speech acts and interviews guided by theory. Results General advice obstructed possibilities for ethical clarification and patient-centredness. Ethical clarification was asked for, and was enhanced by the doctor using communication techniques such as interpretation, summarization, and exploration of the objective, subjective and social dimensions of the patients’ lifeworlds. However, to produce concrete good decisions an additional reflection over possibilities and obstacles in the patient's lifeworld is necessary. Conclusion Consultations concerning lifestyle changes hold opportunities for ethical clarification and reflection which may create decisions rooted in the patient's everyday life. Practice implications The study suggests that GPs should encourage active reflection and deliberation on values and norms in consultations concerning lifestyle changes.

A qualitative study of lifestyle counselling in general practice in Ireland

There is limited information in Ireland on the attitudes of GPs and practice nurses to lifestyle counselling and the strategies or approaches they use. Furthermore, there is no national framework or resources to support the systematic and uniform provision of lifestyle counselling. To explore the views of Irish primary health care practitioners about behavioural risk factor management in particular to the provision of lifestyle counselling. To identify barriers to behavioural risk factor management and to inform the development of a risk factor management toolkit for general practice. The research design is a qualitative study consisting of six focus groups with primary health care practitioners in urban and rural locations in the Republic of Ireland. Two focus groups were conducted with GPs, two with practice nurses, one with a mixed group of GPs and practice nurses and one with a Primary Care Team. In total, 56 participants, aged 30-64 years, attended the focus groups. Descriptive analysis was performed. GPs and practice nurses experienced considerable barriers to lifestyle counselling. These include insufficient time, patient resistance, lack of funding for prevention and lack of training. Participants were aware of the value of patient-centred lifestyle counselling; however, the provision of simple lifestyle information and advice was the predominant strategy used. GPs and practice nurses regularly conduct lifestyle counselling despite considerable barriers. It is essential that they are supported to carry out lifestyle counselling as part of a systematic 'whole practice approach' to prevention in general practice.

Physicians' health practices strongly influence patient health practices.

Physicians' health practices strongly influence patient health practices.

Randomized controlled trial: effect of nutritional counselling in general practice

To investigate the effectiveness of a non-structured 15-min educational intervention by general practitioners (GPs) on modifications of daily diet among healthy adults. Two arms randomized trial lasting 12 months. Italian general practitioner wards. Subjects A total of 3,186 men and women aged 18-65 years recruited in the medical ward by their GPs. An educational intervention and a brochure on the basics of a healthy diet based on the Italian Guidelines for a Correct Nutrition, 1998. The main study goal was to attain an intake of fruits and vegetables >5 servings per day. Follow-up visit every 6 months. Main outcome measures Weight, blood pressure, and a 40-items Food Frequency Questionnaire. The intervention group showed a slightly reduced net intake of meat and a slightly increased net intake of fruits and vegetables, fish products, and olive oil. Body mass index (BMI) changed only in the treatment arm [-0.41 95% confidence interval (95% CI) -0.11 to -0.53]. The net change at 1 year in the intervention arm was +1.31 (CI 0.90-4.39) for fruits and vegetables, and -0.22 (-0.11 to -0.69) for meat (portions per week). We also computed a 'healthy diet score' reflecting compliance with recommended dietary habits. In the intervention group, the mean score at recruitment was significantly lower than the mean score at the end of follow-up (Crude score change = 0.29; CI 0.19-0.48). No differences were observed in the control group (Crude score change = -0.04; CI -0.22-0.02). The difference in score from baseline to the final visit, comparing the intervention vs the control group, was statistically significant (P < 0.001) (MANOVA adjusted by sex, BMI, education, and time). A brief educational intervention by GPs can induce multiple diet changes that may lower BMI and potentially reduce chronic disease risk in generally healthy adults.

Potentials and pitfalls for nutrition counselling in general practice

This paper was based on collaborative research efforts from Wageningen University and the University Medical Centre St Radboud in The Netherlands and describes the rationale for web-based nutrition counselling applications in general practice as well as some of the frequently used models and theories (predominantly the Stages of Change Model). General practitioners can play an important role in cardiovascular risk reduction by giving nutrition counselling to patients at elevated cardiovascular risk. Unfortunately, general practitioners perceive barriers that may limit their nutrition counselling practices. Some of these barriers may be overcome using computer and Internet technologies. Computerized reminders for preventive services, and websites with reliable high-quality information may prove to be valuable additions to usual care. Cooperation with dietitians may also lead to improvements in nutrition counselling in general practice. For example, general practitioners could use their unique position to create awareness and motivation among patients. They could subsequently refer motivated patients to dietitians for detailed personal dietary advice.

Thirty‐six month outcome data from a trial of counselling with chronically depressed patients in a general practice setting

Counsellors have been employed in general practice with little evidence of effectiveness in this setting. This randomized controlled trial examined long-term effectiveness of short-term counselling in general practice for patients with chronic depression, either alone or combined with anxiety. Participants were 181 patients recruited from nine general practitioners' (GP) practices in Derbyshire by screening consecutive attenders using the Beck Depression Inventory. Both the experimental and control group received routine GP treatment but the experimental group were also referred to the practice counsellor. Depression and social adjustment were measured at baseline, 6, 12, and 36 months. There was an overall significant improvement in the actual scores over time, but there were no significant differences between the two groups on any of the measures at either 6, 12, or 36 months. Although fewer experimental group patients were still 'cases' on the BDI than controls at 6 and 12 months, this difference disappeared at 36 months. There was no evidence to demonstrate a long-term effect of improved outcomes in those referred to counselling.

Updating the evidence relating to physical activity intervention studies in older people

For older adults, physical activity (PA) plays a central role in the prevention and management of chronic disease, and has the potential to reduce physical decline, maintain functional ability and prevent injuries. This review provides an update of the evidence relating to the effectiveness of PA intervention studies (both general PA and trials specific to progressive resistance training (PRT)) for older adults. The following electronic databases were searched for articles published since 1999: Medline, PubMed, EMBASE, CINAHL and Sport Discus. For the PRT section, a 2002 Cochrane review was also used. Eight general PA intervention studies were included in this review, ranging from one-on-one counselling in general practice to the community-wide promotion of walking. The aim of most of the trials was to increase moderate and/or vigorous activity levels. Most of the studies reviewed had some degree of success in getting older people to be more active. However, a major limitation was the use of self-report measures of PA. The review of PRT interventions included 21 trials. Participants in half the studies had either functional limitations or a chronic condition. Most trials were conducted in a supervised setting using specialised equipment. Increased strength and improvement in basic functional tasks were generally reported, but there was a paucity of strong evidence linking PRT with reduced physical disability and improved health-related quality of life. While considerable progress is being made in this area, further population-based studies that include home and whole-community interventions are required.

Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial

Objective: To measure the effect of brief behavioural counselling in general practice on patients' consumption of fruit and vegetables in adults from a low income population.Design: Parallel group randomised controlled...

Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial.

Objective: To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease.Design: Cluster randomised...

Nutritional counselling in general practice: a cost effective analysis.

STUDY OBJECTIVE: To study the clinical and cost outcomes of providing nutritional counselling to patients with one or more of the following conditions: overweight, hypertension and type 2 diabetes. DESIGN:...

Promotion of healthy behaviour among adults at increased risk of coronary heart disease in general practice: methodology and baseline data from the Change of Heart study

Previous attempts to influence individuals' behaviour in order to lessen cardiovas cular risk have met with limited success. We report on the way in which the Stages of Change model was used by trained practice nurses in a randomised controlled trial. Patients with one or more modifiable risk factors (regular smoking, high choles terol, or the combination of high body mass index and low physical activity) were recruited during routine care at 20 group general practices in inner city to rural areas over 18 months. Baseline measurements on 883 people show that the control and intervention groups were reasonably matched, with one, two and three risk factors found among approximately 43, 48 and 9 per cent, respectively. Some differences between groups in readiness to modify behaviour as assessed by stage of change were observed. This trial will evaluate systematically the impact of brief behav ioural counselling in general practice.

Nutritional counseling in German general practices: a holistic approach

There is consensus among all German health professionals, including primary care physicians, that a holistic approach to healthy living begins with good nutrition. In northern Baden, 2100 general practitioners and internists were asked about their nutritional attitudes and preventive counseling in daily practice. Of responding physicians, 75% attributed great importance to prevention in general and 92% to nutrition in particular, 65% were providing special programs such as "How to treat diabetes by myself" or "Reducing hypertension by losing weight." Together with the highest German Committee of Physicians, the Lectures in General Medicine of the University of Heidelberg held a meeting on nutritional counseling in general practice. The 23 participants collected statements and information on the topics of education and counseling, support for improved teaching, and knowledge about nutritional attitudes and food. The Heidelberg agreements are as follows: 1) good nutritional counseling can reduce morbidity of important diseases, 2) nutritional counseling must be improved in general practice, 3) diagnosis-related written cases for systematic counseling should be available, 4) family doctors should cooperate with nutritionists, and 5) for quality assurance, the three-level strategy of primary care should be recommended because of the positive results of the Bruchsal-Oestringen program (reduction of obesity and hypercholesterolemia). General practice can become a place of improved nutritional counseling and education if the use of programs proven to be successful, additional exercise-based community approaches, and quality assurance can be facilitated. The outcome of practice-based studies may encourage primary care physicians to spend more time and training on nutrition guidance.

Counselling in general practice: Clients' perceptions of significant events and outcome

An investigation of clients' perceptions of the change process and outcome of counselling in primary care is presented. Significant events were identified by 51 clients post-session for a mean of 4.7 counselling sessions. Outcome was assessed by clients, through their perceptions of goal attainment and change in quality of life from pre-to post-counselling. Four-hundred-and-nine events were categorized by use of the Therapeutic Impact Content Analysis System (TICAS) and a content analysis system was created to categorize clients' goals. Results showed that ‘reassurance’, ‘problem solution ’, ‘insight’ and ‘involvement’ impacts were reported most frequently by clients. No category of significant events was related to change in quality of life. For 11 clients who set goals in the ‘expression’ category, more ‘reassurance’ and fewer ‘problem solution’ impacts were related to attainment of ‘expression’. Some suggestions are made for the lack of significant relationships with overall measures of outcome and it was suggested that more qualitative analysis of the process of outcome is needed.