Herz-Kreislauf-Prävention beim Hausarzt? Erste Ergebnisse einer Studie zu Einstellungen, Angeboten, Erfolgen und Problemen in der Praxis

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.

Schlüsselwörter

Gesundheitsverhalten - Hausarzt - Herz-Kreislauf- Erkrankungen - Lebensstilberatung - Prävention

Keywords

lifestyle counseling - health behavior - general practitioner - cardiovascular diseases - prevention

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