Physical activity of depressed patients and their motivation to exercise: Nordic Walking in family practice.

The objectives of this study were to find out how motivated depressed patients are to exercise regularly, to measure the physical activity of depressed patients and to find out how regular Nordic Walking affects the mood and physical fitness of depressed patients. A cross-sectional study was carried out. Three years after the Prediction of Primary Episodes of Depression in Primary Medical Care study, telephone calls were made to 178 patients who had had depression during that study. We enquired whether and why they would be interested in starting regular Nordic Walking three times a week, at least 30 min at a time, for 24 weeks. Furthermore, there were questions about the patients' earlier physical activity. The Composite International Diagnostic Interview was used to assess depression. To measure physical fitness, we used an outdoor 2 km walking test. Altogether, 106 patients were interviewed, 48 (45%) of them were depressed and 58 (55%) were nondepressed. Of the depressed patients, 16, and of the nondepressed patients, five, started the training programme. During the past 2 years, 12 of the patients had not had any regular physical activity. One-fourth of the depressed patients completed the study. Mean fitness index was 21.99+/-20.38 at week 0 and 38.72+/-26.12 at week 24. The feedback of the patients and their families to the programme was positive. Depressed patients in family practice were physically inactive. About one-third of the depressed patients were motivated to start regular physical activity. Nordic Walking increased the patients' physical activity and improved their mood.

Patient expectations from consultation with family physician.

AIM: To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. METHOD: We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped patients completed a questionnaire about their expectations before and after the consultation. Patient assessment of expected and obtained psychosocial support and biomedical information during the consultation with physician were compared. Two investigators independently assessed patient involvement in the consultation process on the basis of videotaped consultations, using a 5-point scale. RESULTS: Receiving an explanation of biomedical information and discussing psychosocial aspects was assessed as important by 57.4-66.8% and 17.8-36.1% patients, respectively. The physicians did not meet patient expectations in the case of three biomedical aspects of consultation: cause of symptoms, severity of symptoms, and test results. Younger patients evaluated the importance of discussing psychological problems higher than older patients. The involvement of the patients was high in the problem defining process, in the physicians' overall responsiveness to the patients, and in their picking up of the patient's cues. The patients were involved less in the decision making process. CONCLUSION: Discussing biomedical issues was more important for the patients than discussing psychological issues. The patients wanted to hear more about the cause and seriousness of their symptoms and about test results. The family physicians provided more psychosocial care than the patients had expected. Considering high patient involvement in the consultation process and the overall responsiveness of the family physicians to the patients during the consultation, Estonian physicians provide patient-centered consultations.

Structure and duration of consultations in Estonian family practice.

OBJECTIVE: To study the influence of age, gender and the nature of the patient's problems on length of time of consultation in the practices of newly trained family doctors in a recently reconstructed health care system. DESIGN: Video-recordings of consultations with consecutive patients in family practice were studied for duration of consultation in relation to age, gender and nature of the problem(s). SETTING: Primary health care. SUBJECTS: 405 consecutive consultations were video-taped in the practices of 27 family doctors. MAIN OUTCOME MEASURES: Length of time of consultation and its segments was analysed using the Statistical Package for the Social Sciences. The problems were classified according to the ICPC. RESULTS: The average consultation lasted 9.0 min (+/- 4.9). Physical examination was 2.0 min (+/- 1.9) and was performed in 79% of all consultations. Respiratory and circulatory problems were the most common. More than one reason for the encounter was given in one-fourth of cases. Consultation time was longer for older age groups and for patients with psychological problems. CONCLUSION: Video-recording allows consultations to be evaluated directly and is acceptable to patients. The high participation rate of patients in our study can be explained by the individual approach and by the family doctor system. The period of consultation was dependent on patient age and on the number and nature of the problems, but was not influenced by gender.