Putting prevention into practice: qualitative study of factors that inhibit and promote preventive care by general practitioners, with a focus on elderly patients.

BACKGROUND: General practitioners (GPs) have a key role in providing preventive care, particularly for elderly patients. However, various factors can inhibit or promote the implementation of preventive care. In the present study, we identified and examined factors that inhibit and promote preventive care by German GPs, particularly for elderly patients, and assessed changes in physicians' attitudes toward preventive care throughout their careers. METHODS: A qualitative, explorative design was used to identify inhibitors and promoters of preventive care in German general medical practice. A total of 32 GPs in Berlin and Hannover were surveyed. Questions about factors that promote or inhibit implementation of preventive care and changes in physicians' perceptions of promoting and inhibiting factors throughout their careers were identified. Episodic interviews, which encouraged the reporting of anecdotes regarding daily knowledge and experiences, were analyzed using ATLAS/ti. Socio-demographic data of GPs and structural information about their offices were collected using short questionnaires. The factors identified as inhibitory or promoting were classified as being related to patients, physicians, or the healthcare system. The changes in GP attitudes toward preventive care throughout their careers were classified as personal transitions or as social and health policy transitions. RESULTS: Most of the identified barriers to preventive care were related to patients, such as a lack of motivation for making lifestyle changes and a lack of willingness to pay for preventive interventions. In addition, the healthcare system seemed to inadequately promote preventive care, mainly due to poor reimbursement for preventive care and fragmentation of care. GPs own attitudes and health habits seemed to influence the implementation of preventive care. GPs recognized their own lack of awareness of effective preventive interventions, particularly for elderly patients. GPs were motivated by positive preventive experiences, but often lacked the necessary training to counsel and support their patients. CONCLUSIONS: German GPs had positive attitudes towards prevention, but the implementation of preventive care was neither systematic nor continuous. Identification and elimination of barriers to preventive care is crucial. Further research is needed to identify effective practice-based approaches to overcome these barriers.

[Prevention and aging--topics for medical training and continuing education? Analysis of current and future situations]. / Prävention und Alter-- (k)ein Thema in der arztlichen Aus-, Fort- und Weiterbildung? Analyse der bisherigen und zukünftigen Situation.

Due to the current demographic changes, prevention, health promotion, and aging are key topics for future healthcare delivery systems. Interviews with physicians and analyses of the medical training and continuing education show substantial deficits within these areas. The restructuring of the medical training in Germany, together with the introduction of a new boardcertification ordinance, offers the opportunity to strengthen these topics.

Health in the context of growing old: social representations of health.

Senior citizens have become a major part of the clientele of general practitioners and home care nurses due to a major demographic transition in most western countries. How do the health concepts in professional practice reflect these trends? Research has largely investigated the health concepts of lay people. This study is focused on the representations of health in old age held by two groups of professionals--general practitioners and nurses--both working in home care with elderly people in two German cities. The results show how health professionals use an extended concept of health, which focuses on the life situation of the old person, on autonomy, self-determination or independence and on how the elderly manage disease and physical restrictions.