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. 2000 Jun;50(455):455–459.

Can general practitioners influence the nation's health through a population approach to provision of lifestyle advice?

D A Lawlor 1, S Keen 1, R D Neal 1
PMCID: PMC1313722  PMID: 10962782

Abstract

BACKGROUND: Lifestyle advice from general practitioners (GPs) has been shown to have a positive effect on population health. In practice, GPs provide lifestyle advice to a minority of their patients only, those who are high risk or already have symptoms. AIM: To look in depth at GPs' attitudes towards adopting a population approach to lifestyle advice and to use these results to identify ways of maximising the potential of GPs to affect population health. METHOD: Thirty-six GPs, purposively sampled by identifying characteristics likely to affect their health promotion activity, participated in a focus group study. Data from the focus groups were transcribed verbatim and analysed using standard methods. RESULTS: The main themes that emerged suggested that GPs do not take a population approach to lifestyle advice because they prefer a high risk approach and doubt their ability to be effective in a population approach. GPs believed that social, cultural, and environmental factors were the most important determinants of population health. Furthermore, they were concerned about the detrimental effects on the doctor-patient relationship of providing lifestyle advice to all patients. GPs believed that a multi-agency, centrally co-ordinated approach was the preferred way to improve population health and that their role should be limited to secondary prevention. CONCLUSION: Large amounts of resources would be necessary to convince GPs to adopt a population approach to lifestyle advice. Measures to tackle the social and environmental determinants of health may be a more effective and efficient means of improving the nation's health.

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Selected References

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  1. Ashenden R., Silagy C., Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract. 1997 Apr;14(2):160–176. doi: 10.1093/fampra/14.2.160. [DOI] [PubMed] [Google Scholar]
  2. Barbour R. S. Using focus groups in general practice research. Fam Pract. 1995 Sep;12(3):328–334. doi: 10.1093/fampra/12.3.328. [DOI] [PubMed] [Google Scholar]
  3. Blair S. N., Kampert J. B., Kohl H. W., 3rd, Barlow C. E., Macera C. A., Paffenbarger R. S., Jr, Gibbons L. W. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA. 1996 Jul 17;276(3):205–210. [PubMed] [Google Scholar]
  4. Boulton M. G., Williams A. Health education in the general practice consultation: doctors' advice on diet, alcohol and smoking. Health Educ J. 1983;42(2):57–63. doi: 10.1177/001789698304200211. [DOI] [PubMed] [Google Scholar]
  5. Bull F. C., Schipper E. C., Jamrozik K., Blanksby B. A. Beliefs and behaviour of general practitioners regarding promotion of physical activity. Aust J Public Health. 1995 Jun;19(3):300–304. doi: 10.1111/j.1753-6405.1995.tb00448.x. [DOI] [PubMed] [Google Scholar]
  6. Butler C. C., Pill R., Stott N. C. Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion. BMJ. 1998 Jun 20;316(7148):1878–1881. doi: 10.1136/bmj.316.7148.1878. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Coleman T., Wilson A. Anti-smoking advice in general practice consultations: general practitioners' attitudes, reported practice and perceived problems. Br J Gen Pract. 1996 Feb;46(403):87–91. [PMC free article] [PubMed] [Google Scholar]
  8. Coulter A., Schofield T. Prevention in general practice: the views of doctors in the Oxford region. Br J Gen Pract. 1991 Apr;41(345):140–143. [PMC free article] [PubMed] [Google Scholar]
  9. Doll R., Peto R., Wheatley K., Gray R., Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994 Oct 8;309(6959):901–911. doi: 10.1136/bmj.309.6959.901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hart J. T. Coronary heart disease: preventable but not prevented? Br J Gen Pract. 1990 Nov;40(340):441–442. [PMC free article] [PubMed] [Google Scholar]
  11. Hillsdon M. Promoting physical activity: issues in primary health care. Int J Obes Relat Metab Disord. 1998 Aug;22 (Suppl 2):S52–S54. [PubMed] [Google Scholar]
  12. Horobin J. M., Hester S. B., Macdonald S., Baijal E. Obtaining the views of general practitioners on the services to which they refer patients--a locality approach. Br J Gen Pract. 1997 Sep;47(422):571–572. [PMC free article] [PubMed] [Google Scholar]
  13. Kitzinger J. Qualitative research. Introducing focus groups. BMJ. 1995 Jul 29;311(7000):299–302. doi: 10.1136/bmj.311.7000.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Langham S., Gillam S., Thorogood M. The carrot, the stick and the general practitioner: how have changes in financial incentives affected health promotion activity in general practice? Br J Gen Pract. 1995 Dec;45(401):665–668. [PMC free article] [PubMed] [Google Scholar]
  15. Law M., Tang J. L. An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med. 1995 Oct 9;155(18):1933–1941. [PubMed] [Google Scholar]
  16. Lawlor D. A., Keen S., Neal R. D. Increasing population levels of physical activity through primary care: GPs' knowledge, attitudes and self-reported practice. Fam Pract. 1999 Jun;16(3):250–254. doi: 10.1093/fampra/16.3.250. [DOI] [PubMed] [Google Scholar]
  17. Marmot M. G., Smith G. D., Stansfeld S., Patel C., North F., Head J., White I., Brunner E., Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. doi: 10.1016/0140-6736(91)93068-k. [DOI] [PubMed] [Google Scholar]
  18. McAvoy B. R., Kaner E. F., Lock C. A., Heather N., Gilvarry E. 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 Mar;49(440):187–190. [PMC free article] [PubMed] [Google Scholar]
  19. Stott N. C., Davis R. H. The exceptional potential in each primary care consultation. J R Coll Gen Pract. 1979 Apr;29(201):201–205. [PMC free article] [PubMed] [Google Scholar]
  20. Tang J. L., Armitage J. M., Lancaster T., Silagy C. A., Fowler G. H., Neil H. A. Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects. BMJ. 1998 Apr 18;316(7139):1213–1220. doi: 10.1136/bmj.316.7139.1213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. The new NHS: medical students say no . BMJ. 1998 Apr 18;316(7139):1213A–1213A. [PMC free article] [PubMed] [Google Scholar]
  22. Wallace P. G., Brennan P. J., Haines A. P. Are general practitioners doing enough to promote healthy lifestyle? Findings of the Medical Research Council's general practice research framework study on lifestyle and health. Br Med J (Clin Res Ed) 1987 Apr 11;294(6577):940–942. doi: 10.1136/bmj.294.6577.940. [DOI] [PMC free article] [PubMed] [Google Scholar]

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