How are people with obesity managed in primary care? – results of a qualitative, exploratory study in Germany 2022
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SUBMITTER: Wangler J
PROVIDER: S-EPMC10641940 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundClimate change is the greatest threat to global health in the twenty first century, yet combating it entails substantial health co-benefits. Physicians and other health professionals have not yet fully embraced their responsibilities in the climate crisis, especially about their communication with patients. While medical associations are calling on physicians to integrate climate change into health counselling, there is little empirical evidence about corresponding perceptions of patients.ObjectivesThis study aimed to explore primary care patients' perceptions of climate-sensitive health counselling.MethodsFrom July to December 2021, 27 qualitative interviews with patients were conducted and analysed using thematic analysis. A purposive sampling technique was applied to identify patients who had already experienced climate-sensitive health counselling in Germany.ResultsPatients' perceptions of climate-sensitive health counselling were characterised by a high level of acceptance, which was enhanced by stressing the link between climate change and health, being credible concerning physician's own climate-friendly lifestyle, building upon good therapeutic relationships, creating a sense of solidarity, and working in a patient centred manner. Challenges and risks for acceptance were patients' disinterest or surprise, time constraints, feared politicisation of consultations, and evoking feelings of guilt and shame.ConclusionThese findings suggest that primary care patients can accept climate-sensitive health counselling, if it follows certain principles of communication, including patient-centredness. Our findings can be useful for developing communication guidelines, respective policies as well as well-designed intervention studies, which are needed to test the health and environmental effects of climate-sensitive health counselling.
| S-EPMC10773651 | biostudies-literature
Project description:BackgroundObesity poses severe challenges for the health care system. GPs are in an advantageous position to contribute to preventing obesity by diagnosing patients and initiating treatment. Sporadic studies have shown that attitudes towards obesity management in primary care can have a major influence on treating patients successfully.ObjectivesThe study focuses on attitudes and behavioural patterns towards obesity patients, willingness to provide care, approaches and strategies, and the challenges experienced.MethodsAfter developing the interview guides based on a literature review, 36 GPs in North Rhine-Westphalia and Saarland, Germany, were interviewed between November 2019 and March 2020. Using qualitative typing according to Kluge, different prototypes of GPs were formed. The dimensions of the interview guides were used for deriving the prototypes.ResultsGPs were categorised into four types depending on how they saw themselves and their role in treating patients. The first type (the resigned) was conspicuous through its negative attitude towards obesity management and a lack of willingness to provide care. The second type (the instructors) emphasised the value of active exercise, diet and health promotion, while the third type (the motivators) saw psychosocial support and motivation as a key element in helping patients. In contrast, type four (the educators) focussed primarily on early prevention through patient education.ConclusionDepending on which (proto-)type a patient visits, different focuses and strategies are pursued for obesity management and doctor-patient communication. This results in different perspectives and chances of success about therapeutic measures.
| S-EPMC7993392 | biostudies-literature
Project description:ObjectiveTo explore health care professionals' (HCPs) perspectives, experiences and preferences towards digital technology use in routine palliative care delivery.MethodsHCPs (n = 19) purposively selected from a sample of settings that reflect routine palliative care delivery (i.e. specialized outpatient palliative care, inpatient palliative care, inpatient hospice care in both rural and urban areas of the German states of Brandenburg and Berlin) participated in an explorative, qualitative study using semi-structured interviews. Interview data were analyzed using structured qualitative content analysis.ResultsDigital technologies are widely used in routine palliative care and are well accepted by HCPs. Central functions of digital technologies as experienced in palliative care are coordination of work processes, patient-centered care, and communication. Especially in outpatient care, they facilitate overcoming spatial and temporal distances. HCPs attribute various benefits to digital technologies that contribute to better coordinated, faster, more responsive, and overall more effective palliative care. Simultaneously, participants preferred technology as an enhancement not replacement of care delivery. HCPs fear that digital technologies, if overused, will contribute to dehumanization and thus significantly reduce the quality of palliative care.ConclusionDigital technology is already an essential part of routine palliative care delivery. While generally perceived as useful by HCPs, digital technologies are considered as having limitations and carrying risks. Hence, their use and consequences must be carefully considered, as they should discreetly complement but not replace human interaction in palliative care delivery.
| S-EPMC9745710 | biostudies-literature
Project description:Medical guidelines aim to ensure that care processes take place in an evidence-based and structured manner. They are especially relevant in outpatient primary care due to the wide range of symptoms and clinical pictures. In German-speaking countries, there is a lack of current findings documenting general practitioners' opinions and experiences regarding guidelines, their expectations and their views on what improvements could be made to increase the use of this type of evidence-based instrument in the primary care setting. Between April and August 2020, a total of 3098 general practitioners were surveyed in the states of Baden-Württemberg, Hesse and Rhineland-Palatinate via an online questionnaire. Alongside the descriptive evaluation, t‑testing was used to determine significant differences between two independent sampling groups. A factor analysis was also used to cluster the expectations of those surveyed regarding the fulfilment of requirements relating to guidelines. A total of 52% of those surveyed have a positive view of guidelines. Overall, guidelines are associated with an increased evidence-based approach (69%), standardisation of diagnosis and treatment (62%) and a reduction in overprovision or underprovision of care (57%). In all, 62% of the physicians who implemented guidelines observed positive effects on the quality of care provided, and 67% reported that the implementation of guidelines improved the quality of their diagnostic or therapeutic skills. However, implementation is often seen as being complicated (43%) and restricting the physician's ability to act independently (63%). Survey participants suggested that guidelines could be optimised by giving greater consideration to nondrug alternatives (46%), focusing on issues related to quality of life (42%) and offering a comparative assessment of various treatment options (39%). In order to further promote the attractiveness of guidelines for primary care the design of guidelines should be oriented more towards their application; they should be well-presented to make them easier to implement. The scope of action available to the physician should be stressed. The guidelines should provide recommendations on opportunities for the delegation of tasks within practice teams.
| S-EPMC8484242 | biostudies-literature
Project description:Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown.To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness trial.Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites. Participants received measurement-based care with 5 recommended treatment visits, manualized pharmacotherapy, ongoing support and guidance by a clinical research coordinator, the use of structured evaluation of depressive symptoms and side effects at each visit, and a centralized treatment monitoring and feedback system.A total of 2,876 previously established outpatients in primary (n = 1091) or specialty (n = 1785) with nonpsychotic depression who had at least 1 post-baseline measure.Remission (Hamilton Depression Rating Scale for Depression [Hamilton] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [QIDS-SR(16)]); response (QIDS-SR(16)); time to first remission (QIDS-SR(16)). Remission rates by Hamilton (26.6% PC vs 28.0% SC, p = .40) and by QIDS-SR(16) (32.5% PC vs 33.1% SC, p = .78) and response rates by QIDS-SR(16) (45.7% PC vs 47.6% SC, p = .33) were not different. For those who reached remission or response at exit, the time to remission (6.2 weeks PC vs 6.9 weeks SC, p = .12) and to response (5.5 weeks PC vs 5.4 weeks SC, p = .97) did not differ by setting.Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided.
| S-EPMC2324144 | biostudies-literature
Project description:ObjectiveTo explore experiences, needs and rehabilitation priorities of patients who had their stroke and the experiences of therapists managing stroke patients during the COVID-19 pandemic.DesignExploratory qualitative study.SettingAcute, sub-acute and community stroke facilities.SubjectsTwenty-two participants. Twelve therapists (all female, mean age 38.5 years) and ten patients (9 female, mean age 51.1 years) who were involved in stroke rehabilitation during the pandemic were interviewed.MethodsIndividual semi-structured interviews were conducted. Interviews were recorded and transcribed before being analysed using a reflexive thematic analysis approach.ResultsFour main themes demonstrate the modifications in the care system as a result of COVID-19, impact on the stroke patients at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. Remote rehabilitation and self-management strategies were recommended to deliver care for stroke patients. However, therapists seemed unsatisfied with the quality of care delivered and patients suggested face to face delivery of care with proper personal protection equipment to better address their physical and mental health needs.ConclusionThe findings of this study explored the impact of the pandemic on stroke care from the perspective of the patients and therapists and provides suggestions for improved delivery of care in similar situations. Future research is warranted to examine the long-term effects on people who had inadequate post-stroke rehabilitation during covid pandemic and urgent measures taken to reduce the impact the pandemic has had on the physical and mental issues for these patients.
| S-EPMC9974115 | biostudies-literature
Project description:Time and again, it is discussed that in medical practices, the number of patients who develop health anxieties due to extensive health information searches on the Internet is increasing. The objective of this study is to explore and describe general practitioners' experiences and attitudes towards cyberchondria patients as well as strategies to stabilize affected patients. Following a qualitative approach, oral personal semi-standardized interviews with general practitioners (N = 38) in Rhineland-Palatinate, Germany, were conducted in 2019. In the course of a content analysis, one can see that most interviewees see the emergence of Internet-related health anxieties as an increasing problem in everyday care. Affected patients not only show marked levels of doubt and nervousness as well as hypersensitivity to their own state of health, but also low confidence in the physician. In addition to compliance-related difficulties, the high need for advice and the demand for further diagnostics are regarded as major problems. Various approaches were identified by which general practitioners respond to unsettled patients (more consultation time, recommendation of reputable websites, information double-checking, expanded history questionnaire, additional psychosocial training).
| S-EPMC7518985 | biostudies-literature
Project description:BackgroundPrimary care physicians (PCPs) are in a critical position for identifying, preventing and treating childhood obesity. However, a one-size-fits-all approach does not exist for having conversations about weight with families. A better understanding of how PCPs can address paediatric patients' weight concerns is needed in order to develop effective guidelines and trainings.ObjectiveTo describe PCPs preferences and behaviours regarding weight-related conversations with paediatric patients' and their families.MethodsTwenty PCPs affiliated with the University of Minnesota, USA, were recruited to participate in semi-structured interviews. Transcripts were analysed using inductive thematic analysis.ResultsPCP's identified well-child visits as the most appropriate time for weight-related discussions with families. Physicians described what approaches/elements they perceived to work best during conversations: collaboration, empathy, health-focused and objective measures.ConclusionsOverall, PCPs were more comfortable with weight-related discussions during annual well-child visits and rarely initiated them during an acute visit or the first encounter with a patient. Objective measures, such as growth charts, were often utilized to start discussions. Considering a large proportion of well-child visits are missed, alternative opportunities to have discussions about healthy lifestyle behaviours should be explored. The integral role PCPs play in paediatric obesity warrants further research.
| S-EPMC8414925 | biostudies-literature
Project description:BackgroundPreventing childhood obesity is a public health priority, and primary care is an important setting for early intervention. Authors of a recent national guideline have identified a need for effective primary care interventions for obesity prevention and that parent perspectives on interventions are notably absent from the literature. Our objective was to determine the perspectives of primary care clinicians and parents of children 2-5 years of age on the implementation of an obesity prevention intervention within team-based primary care to inform intervention implementation.MethodsWe conducted focus groups with interprofessional primary care clinicians (n = 40) and interviews with parents (n = 26). Participants were asked about facilitators and barriers to, and recommendations for implementing a prevention program in primary care. Data were recorded and transcribed, and we used directed content analysis to identify major themes.ResultsBarriers existed to addressing obesity-related behaviours in this age group and included a gap in well-child primary care between ages 18 months and 4-5 years, lack of time and sensitivity of the topic. Trust and existing relationships with primary care clinicians were facilitators to program implementation. Offering separate programs for parents and children, and addressing both general parenting topics and obesity-related behaviours were identified as desirable.InterpretationDespite barriers to addressing obesity-related behaviours within well-child primary care, both clinicians and parents expressed interest in interventions in primary care settings. Next steps should include pilot studies to identify feasible strategies for intervention implementation.
| S-EPMC4933605 | biostudies-literature
Project description:BackgroundThere is a scarcity of data on the epidemiology of hypertension and its treatment in Germany in recent years.ObjectivesThe present study aimed to investigate trends in the number of adults diagnosed with hypertension and those being prescribed antihypertensive drugs each year in general practices from this country between 2013 and 2022.MethodsThis retrospective cohort study used data of adults aged ≥18 years continuously collected from 336 general practices in Germany (IQVIA) during 2013-2022. The diagnosis of hypertension and the prescription of antihypertensive drugs were coded using the ICD-10 and the EphMRA classification, respectively. Covariates included the total number of patients, mean (SD) age of patients, and proportion of women per practice. Trends in hypertension diagnosis and treatment were studied using linear regression models.ResultsThe mean (SD) total number of patients per practice ranged from 2,235 (1,055) in 2013-2,845 (2,090) in 2021 (p-value < 0.001). The mean (SD) age of patients per practice was between 48.4 (21.5) and 50.5 (21.4) years, while the proportion of women was 52.1%-53.9% (p-values < 0.001). After adjusting for covariates, there was a significant decrease in the number of patients diagnosed with hypertension (beta coefficient = -7.91, p-value < 0.001) and treated with any antihypertensive drug per practice per year between 2013 and 2022 (beta coefficient = -5.40, p-value < 0.001).ConclusionThis study identified decreasing trends in the diagnosis and treatment of hypertension in general practices in Germany in the last decade. These data may suggest that the prevention of hypertension has improved in this country in recent years.
| S-EPMC11204120 | biostudies-literature