Abstract
The prevention scheme called “Rezept für Bewegung” (Physical Activity on Prescription,
PAP) enables physicians to formally prescribe participation in health-oriented sports
programs to their patients. The PAP scheme aims to strengthen the binding character
of physicians’ patient counselling for physical activity. The research objective was
to investigate the physicians’ awareness and their use of PAP as a prevention tool
in patient counselling, as well as perceived barriers to implementation.
A cross-sectional total population mail questionnaire survey was performed in two
districts of Bavaria. 2,821 physicians in private practice were contacted; the response
rate was 32.7 %. Descriptive data analysis of 923 questionnaires was carried out using
SPSS.
Only 26.4 % of the respondents (244/923) were familiar with the PAP scheme, and only
7.7 % (71/923) used PAP at least once a month when counselling their patients. Key
barriers to implementation include lack of information on the prevention scheme, a
limited choice of local matching sports programs and an unclear commitment of health
insurances to reimburse patients for participation fees. Every third physician distrusts
PAP to be an efficient way of improving physical activity in patients.
To foster the implementation of PAP in the future, awareness-raising campaigns and
an expansion of sports programs might be helpful. In order to strengthen the physicians’
confidence in the effectiveness of preventive patient counselling on physical activity,
existing research evidence needs to be spread among physicians.
Zusammenfassung
Im Rahmen der Präventionsmaßnahme „Rezept für Bewegung“ können Ärzte ihren Patienten
die Teilnahme an gesundheitsorientierten Sportangeboten auf Rezept verschreiben. Das
Rezept für Bewegung zielt damit darauf ab, mehr Verbindlichkeit in der ärztlichen
Präventionsberatung herzustellen. In der vorliegenden Studie wurde untersucht, ob
niedergelassene Ärzte das Rezept für Bewegung kennen, wie sie es im Rahmen ihrer Patientenberatung
anwenden und welche wahrgenommenen Barrieren sie für eine Umsetzung in der Praxis
sehen.
In einer Vollerhebung wurden in zwei bayerischen Regierungsbezirken 2.821 niedergelassene
Ärzte mit einem standardisierten Fragebogen befragt. Bei einer Rücklaufquote von 32.7%
konnten 923 Fragebögen in die deskriptive Datenanalyse mit SPSS eingeschlossen werden.
Nur 26.4% der befragten Ärzte (244/923) kennen das Rezept für Bewegung und nur 7.7%
(71/923) wenden das Rezept mindestens einmal im Monat im Rahmen ihrer Patientenberatung
an. Hinderungsgründe sind vor allem fehlende Informationen über die Maßnahme, eine
geringe Auswahl an passenden Sportangeboten vor Ort und die Unsicherheit, inwieweit
die Krankenkassen die Teilnahmegebühren an Patienten rückerstatten. Jeder dritte Arzt
bezweifelt, dass das Rezept für Bewegung ein effektiver Weg zur Förderung von körperlich-sportlicher
Aktivität bei Patienten ist.
Informationskampagnen zur Sensibilisierung der Ärzte und eine Ausweitung des Sportangebots
scheinen deshalb sinnvolle Maßnahmen, um die Implementation des Rezepts für Bewegung
zukünftig zu stärken. Ärzte sollten zudem gezielt über die Evidenz zu ärztlicher Präventionsberatung
informiert werden, um ihre Zuversicht in die Effektivität ihrer Beratungsleistung
zu stärken.
Keywords
Schlüsselwörter
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References
WHO. The world health report 2002: Reducing risks, promoting healthy life In: WHO. Geneva 2002.
- Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study.Brit Med J. 2013; 347: f5577
- Evidence for prescribing exercise as therapy in chronic disease.Scand J Med Sci Sports. 2006; 16: 3-63
Exercise is Medicine: http://exerciseismedicine.org/, 2015 (accessed 12.12.2015).
General Medical Council of Germany: Physical Activity on Prescription. 2014.
German Olympic Sports Conferderation (DOSB): Physical Activity on Prescription http://www.dosb.de/ru/sportentwicklung/sportentwicklungs-news/detail/news/einheitliches_rezept_fuer_bewegung/, 2015 (accessed 10.12.2015).
- The effect of physical activity advice given in routine primary care consultations: a systematic review.Journal of public health medicine. 2001; 23: 219-226
- Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review.Br J Gen Pract. 2007; 57: 979-986
- Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial.Arch Intern Med. 2009; 169: 694-701
- The green prescription study: A randomized controlled trial of written exercise advice provided by general practitioners.Amer J Public Health. 1998; 88: 288-291
- Planning Committee of the Addressing Multiple Behavioral Risk Factors in Primary Care, Multiple behavioral risk factor interventions in primary care. Summary of research evidence.Am J Prev Med. 2004; 27: 61-79
- Factors contributing to the effectiveness of physical activity counselling in primary care: a realist systematic review.Patient education and counseling. 2015; 98: 412-419
- Effectiveness of general practice-based physical activity promotion for older adults: systematic review.Primary health care research & development. 2014; 15: 190-201
- Physical activity on prescription in primary health care: a follow-up of physical activity level and quality of life.Scand J Med Sci Sports. 2008; 18: 154-161
- Physical activity on prescription schemes (PARS): do programme characteristics influence effectiveness? Results of a systematic review and meta-analyses.BMJ open. 2017; 7: e012156
- Population physical activity behaviour change: A review for the European College of Sport Science.Eur J Sport Sci. 2012; 12: 367-383
Sport Pro Gesundheit (“Exercise for Health”): http://www.sportprogesundheit.de/de/sport-und-gesundheit/sport-pro-gesundheit/, 2017 (accessed 05.12.2017).
- Gaps between knowing and doing: understanding and assessing the barriers to optimal health care.J of continuing education in the health professions. 2007; 27: 94-102
Kassenärztliche Vereinigung Bayern (Association of Statutory Health Insurance Physicians in Bavaria): www.kvb.de, 2015 (accessed 08.12.2015).
- Attitudes, norms and controls influencing lifestyle risk factor management in general practice.BMC Fam Pract. 2009; 10: 59
- Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study.BMC Fam Pract. 2013; 14: 20
- Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners.Prev Med. 1995; 24: 546-552
- Get moving! Physical activity counseling in primary care.J Am Acad Nurse Pract. 2007; 19: 349-357
- Primary care physicians’ knowledge, attitudes, beliefs and practices regarding childhood obesity: a systematic review.Obes Rev. 2009; 10: 227-236
- Why don’t physicians follow clinical practice guidelines? A framework for improvement.JAMA. 1999; 282: 1458-1465
Präventionsgesetz (Prevention Act): www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/p/praeventionsgesetz.html, 2017 (accessed 16.12.2017).
- Overweight and obesity: knowledge, attitudes, and practices of general practitioners in france.Obes Res. 2005; 13: 787-795
- 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
- Primary prevention in general practice - views of German general practitioners: a mixed-methods study.BMC Fam Pract. 2014; 15: 103
- Obesity management: Australian general practitioners’ attitudes and practices.Obesity Res. 2000; 8: 459-466
- Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues.Arch Pediatr Adolesc Med. 1999; 153: 629-635
- Health professionals’ perspectives on exercise referral and physical activity promotion in primary care: Findings from a process evaluation of the National Exercise Referral Scheme in Wales.Health Educ J. 2015; 74: 743-757
- Putting prevention into practice: qualitative study of factors that inhibit and promote preventive care by general practitioners, with a focus on elderly patients.BMC Fam Pract. 2010; 11: 68
- Cardiovascular prevention at the general practitioner? First results of a study on attitudes, services, success and barriers in practice.Dtsch Med Wochenschr. 2012; 137: 17-22
- Prevention and health promotion in clinical practice: the views of general practitioners in Europe.Prev Med. 2005; 40: 595-601
- General practitioners’ views and experiences of counselling for physical activity through the New Zealand Green Prescription program.BMC Fam Pract. 2011; 12: 119
- Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review.Brit J of Sports Medicine. 2012; 46: 625-631
- Prevalence and temporal trends of physical activity counselling in primary health care in Germany from 1997-1999 to 2008-2011.The international journal of behavioral nutrition and physical activity. 2015; 12: 136
- Training for physicians for physical activity promotion in older adults. Needs assessment and formative evaluation of a first offer.Präv Gesundheitsf. 2017; 12: 218-226
- Counseling for physical activity in overweight and obese patients.American Fam Physician. 2003; 67: 1249-1256
- The Swedish approach on physical activity on prescription.Clinical Health Promotion. 2016; 6 (31.3)
- How to make exercise counseling more effective: Lessons from rural America.J Fam Practice. 2008; 57: 394-402
Article Info
Publication History
Published online: February 24, 2018
Accepted:
February 2,
2018
Received in revised form:
January 29,
2018
Received:
August 25,
2017
Identification
Copyright
© 2018 Published by Elsevier Inc.
