چکیده (انگلیسی):

Background:Policy efforts focus on a reorientation of health care systems towards primary prevention. To guide
such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs)
attitudes toward primary prevention.
Methods:Mixed-method study including a cross-sectional survey of all community-based GPs and focus groups in
a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs
474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines
were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention.
Results:Most respondents considered primary prevention within their realm of responsibility (70%). Primary
prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care
recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of
alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18%
claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned
about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant
to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a
network of societal and municipal institutions.
Conclusions:The mixed-method study showed that primary prevention approaches such as lifestyle counseling
is not well established in primary care. GPs used a selective approach to offer preventive advice based upon
indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good
patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral
approach to population health. This type of restructuring of the health care sector may benefit patients who are
unable to afford specific prevention programmes and who have competing demands that hinder their ability to
focus on behavior change.