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Physical activity referrals in Swedish primary health care: prescriber and patient characteristics, reasons for prescriptions, and prescribed activities
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences. (HELIX Vinn Excellence Centre)ORCID iD: 0000-0002-8031-7651
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2008 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 8, no 201Article in journal (Refereed) Published
Abstract [en]

Background: Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries.

Methods: Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff.

Results: During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week.

The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%).

Conclusion: Östergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.

Place, publisher, year, edition, pages
2008. Vol. 8, no 201
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16823DOI: 10.1186/1472-6963-8-201OAI: oai:DiVA.org:liu-16823DiVA: diva2:174268
Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Activating People: Physical activity in the general population and referral schemes among primary health care patients in a Swedish county
Open this publication in new window or tab >>Activating People: Physical activity in the general population and referral schemes among primary health care patients in a Swedish county
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this thesis the need for physical activity interventions is investigated in a general adult population, the characteristics of physical activity referral (PAR) scheme recipients and referral practitioners, and the effectiveness of PAR in a routine primary health-care (PHC) setting in the county of Östergötland, Sweden. The thesis consists of four papers: three papers are based on a quantitative, uncontrolled prospective PAR study and one paper is based on a population survey in the county of Östergötland, Sweden.

In 2006, only one in four of the adult population, aged 18–84 years, in Östergötland was considered sufficiently active to meet the Swedish national public health recommendations, stated as “30 minutes of moderate physical activity a day”. More than one-third (37%) reported that they hade no intentions to change their physical activity levels, while 36% had thought about change, and 27% were determined to change. Although the individuals felt a large responsibility for their own physical activity, they also believed that this responsibility is partly shared by health-care providers. Among those who wanted to increase their physical activity level, almost one in seven of the total population and one in four among those reporting poor general health, with a BMI over 30 and those who were inactive reported that they wanted support to bring about this change. More than half of them wanted this support from their health-care provider.

During 2004 and 2005, a total of 6300 patients received PARs as part of the Östergötland PAR scheme. Two-thirds of the patients were female and half of the patients were 45–64 years old. The PAR scheme reached a relatively high proportion of physically inactive people. PARrelated statistics, including the numbers of referrals made at individual PHC centres and by different professional categories, showed large differences in prescribing activities, both by patient categories, and by prescribing professionals, indicating great potential for further improvements of this scheme in the future.

Half of the patients (51%) who received PARs were recommended home-based activities, such as walking. Patient follow-up showed that an increase in self-reported physical activity level was achieved by 52% of the patients at the 12-month follow-up. The proportion of inactive patients decreased from 33% at baseline to 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 32% at 12 months. Neither patient age, diagnosis/PAR reason nor the profession of the prescriber were associated with differences in effectiveness. Low activity levels at baseline and homebased activities were significantly associated with increased physical activity at 12 months. Half of the patients (50%) achieved adherence to PARs at the 12-month follow-up, with adherence assessed by simply asking the patients about their adherence to prescribed activity. Patients’ activity levels at baseline (being at least somewhat physically active) and being issued home-based activities were significantly associated with higher adherence at 12 months.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 100 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1096
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16825 (URN)978-91-7393-710-8 (ISBN)
Public defence
2009-03-11, Aulan i Hälsans hus, ingång 16, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-20 Created: 2009-02-20 Last updated: 2017-06-30Bibliographically approved

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Leijon, Matti E.Bendtsen, PrebenNilsen, PerEkberg, Kerstin

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