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DOI: 10.1055/s-0031-1292884
Herz-Kreislauf-Prävention beim Hausarzt? Erste Ergebnisse einer Studie zu Einstellungen, Angeboten, Erfolgen und Problemen in der Praxis
Cardiovascular prevention at the general practitioner? First results of a study on attitudes, services, success and barriers in practicePublication History
07 March 2011
29 September 2011
Publication Date:
16 December 2011 (online)
![](https://www.thieme-connect.de/media/dmw/20120102/lookinside/thumbnails/10.1055-s-0031-1292884-1.jpg)
Zusammenfassung
Hintergrund und Fragestellung: Bisher lagen für die hausärztliche Versorgung in Deutschland keine detaillierten Daten zum Angebot an Lebensstilberatung und anderen kardiovaskulär-präventiven Maßnahmen vor. Ziele dieser Studien war die Analyse solcher Präventionsangebote und die Identifikation förderlicher und hinderlicher Faktoren.
Methodik: Von 2000 zufällig ausgewählten baden-württembergischen Hausärzten nahmen 260 (13 %) an der Studie teil und wurden zur Lebensstilberatung und anderen Präventionsmaßnahmen, deren Barrieren sowie ihrer persönlichen Einstellung befragt. Die mit der Lebensstilberatung assoziierten Faktoren wurden mittels Chi²-Tests und logistischer Regressionsanalyse untersucht.
Ergebnisse: Die befragten Ärzte hatten eine generell positive Einstellung gegenüber Gesundheitsförderung und Prävention. Vier von zehn Ärzten führten Lebensstilberatungen bzgl. Ernährung, körperlicher Aktivität, Tabak- und Alkoholkonsum bei der Mehrheit ihrer Patienten durch. In Praxen mit Ärztinnen (Odds Ratio, OR: 1,98), in denen der Arzt von seinem Angebot an Lebensstilberatung überzeugt war (OR: 3,55) und in denen Fragebögen zur Erfassung von Risikofaktoren im Wartezimmer auslagen (OR: 2,26; alle p < 0,05), fand Lebensstilberatung tatsächlich auch eher statt. Die größten Barrieren gegen Präventionsangebote waren mangelnde Patientenadhärenz (91 %), unzureichende Vergütung (80 %) und Zeitmangel (70 %).
Schlussfolgerung: Offenbar herrscht eine Diskrepanz zwischen dem Potenzial und der Umsetzung von kardiovaskulär-präventiven Maßnahmen im hausärztlichen Setting. Spezielle Schulungen der Ärzte sowie verbesserte finanzielle und organisatorische Rahmenbedingungen könnten zu einer Verbesserung des Präventionsangebotes beitragen.
Abstract
Background: There is a lack of detailed data about lifestyle counseling and other cardiovascular preventive services in primary care settings in Germany. The objectives of this study were to analyze the provision of these services and to identify associated factors.
Methods: 260 (13 %) out of 2,000 randomly selected general practitioners from Southern Germany, took part in this study and were asked about lifestyle counseling and other preventive services as well as barriers and attitudes. Factors associated with lifestyle counseling were analyzed using chi-square tests and logistic regression.
Results: Participating physicians had positive attitudes towards health promotion and prevention. Four out of ten physicians counseled the majority of their patients about diet, physical activity, tobacco and alcohol consumption. Female physicians (odds ratio, OR: 1,98), physicians who were confident about their preventive services (OR: 3,55) and those having risk factor questionnaires in the waiting room (OR: 2,26; all p < 0,05) were more likely to counsel their patients. The most important barriers towards preventive services were patients’ lack of adherence (91 %), inadequate reimbursement (80 %) and lack of time (70 %).
Conclusion: There is a discrepancy between the potential and the implementation of cardiovascular-preventive services in primary care settings. Special trainings of physicians as well as better financial and organizational conditions might help to improve the provision of preventive care.
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Literatur
- 1 Ammerman AS, Devellis RF, Carey TS et al. Physician-based diet counseling for cholesterol reduction: current practices, determinants, and strategies for improvement. Prev Med 1993; 22: 96-109
- 2 Bahrs O. Mein Hausarzt hat Zeit für mich – Wunsch und Wirklichkeit. Ergebnisse einer europäischen Gemeinschaftsstudie. GGW 2003; 3: 17-23
- 3 Castaldo J, Nester J, Wasser T et al. Physician attitudes regarding cardiovascular risk reduction: the gaps between clinical importance, knowledge, and effectiveness. Dis Manag 2005; 8: 93-105
- 4 Doroodchi H, Abdolrasulnia M, Foster JA et al. Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events. BMC Fam Pract 2008; 9: 42
- 5 Ellerbeck EF, Ahluwalia JS, Jolicoeur DG et al. Direct observation of smoking cessation activities in primary care practice. J Fam Pract 2001; 50: 688-693
- 6 Ezzati M, Hoorn SV, Rodgers A et al. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 2003; 362: 271-280
- 7 Frijling BD, Lobo CM, Hulscher ME et al. Provision of information and advice in cardiovascular care: clinical performance of general practitioners. Patient Educ Couns 2002; 48: 131-137
- 8 Gohlke H, Schirmer A, Theobald KH. Kardiovaskuläre Risikostratifizierung in der Allgemeinpraxis. Die Erfahrungen der Scoring-Woche 2002. Z Kardiol 2004; 93: II26-32
- 9 Haskell WL. Cardiovascular disease prevention and lifestyle interventions: effectiveness and efficacy. J Cardiovasc Nurs 2003; 18: 245-255
- 10 Heidrich J, Behrens T, Raspe F et al. Knowledge and perception of guidelines and secondary prevention of coronary heart disease among general practitioners and internists. Results from a physician survey in Germany. Eur J Cardiovasc Prev Rehabil 2005; 12: 521-529
- 11 Hobbs FD, Erhardt L. Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Fam Pract 2002; 19: 596-604
- 12 Holund U, Thomassen A, Boysen G et al. Importance of diet and sex in prevention of coronary artery disease, cancer, osteoporosis, and overweight or underweight: a study of attitudes and practices of Danish primary care physicians. Am J Clin Nutr 1997; 65: 2004S-2006S
- 13 Hulscher ME, van Drenth BB, Mokkink HG et al. Barriers to preventive care in general practice: the role of organizational and attitudinal factors. Br J Gen Pract 1997; 47: 711-714
- 14 Kellerman SE, Herold J. Physician response to surveys. A review of the literature. Am J Prev Med 2001; 20: 61-67
- 15 Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med 1995; 24: 546-552
- 16 Lobo CM, Frijling BD, Hulscher MEJL et al. Organisational determinants of cardiovascular prevention in general practice. Scand J Prim Health Care 2003; 21: 99-105
- 17 McAvoy BR, Kaner EF, Lock CA et al. Our Healthier Nation: are general practitioners willing and able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling. Br J Gen Pract 1999; 49: 187-190
- 18 Mohler 3rd ER, Treat-Jacobson D et al. Utility and barriers to performance of the ankle-brachial index in primary care practice. Vasc Med 2004; 9: 253-260
- 19 Mosca L, Linfante AH, Benjamin EJ et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation 2005; 111: 499-510
- 20 Oriol-Zerbe C, Abholz HH. Primary prevention of cardiovascular diseases by lipid-lowering treatment in German general practice: results from GPs ignoring guidelines and risk calculators. Eur J Gen Pract 2007; 13: 27-34
- 21 Steptoe A, Doherty S, Kendrick T et al. Attitudes to cardiovascular health promotion among GPs and practice nurses. Fam Pract 1999; 16: 158-163
- 22 Tsui JI, Dodson K, Jacobson TA. Cardiovascular disease prevention counseling in residency: resident and attending physician attitudes and practices. J Natl Med Assoc 2004; 96: 1080-1083
- 23 Walsh JM, Swangard DM, Davis T et al. Exercise counseling by primary care physicians in the era of managed care. Am J Prev Med 1999; 16: 307-313