Helping GPs promote exercise: Motivate to Move

Guest Blog from Dr Brian Johnson MRCGP

Honorary Medical Advisor for Public Health Wales

 “The potential benefits of physical activity to health are huge. If a medication existed which had a similar effect, it would be regarded as a ‘wonder drug’ or ‘miracle cure’ ” Professor Sir Liam Donaldson, 2010.

·         Physical inactivity kills more than smoking, diabetes and obesity combined.

·         Exercise as prevention or treatment now features in 39 UK national guidelines.

 So what can we as GPs do?

The vast majority of GP’s acknowledge that promoting increased activity is important in primary care, but sadly the evidence shows that the giving of physical activity guidelines and exercise advice are inconsistent. Many GP’s cite lack of time and resources as barriers to routinely giving advice on physical activity and a recent review¹ of primary care perceptions of physical activity cited lack of training and lack of knowledge as a primary barrier to counselling efforts.

In response to this the Motivate 2 Move website has been developed and endorsed by RCGP Wales as a comprehensive educational package designed to tackle the barriers identified above. It aims to increase the health professional’s ability to incorporate exercise advice routinely within patient consultations.

Designed as brief bites of information but with links to more detailed material for those who need it, the site comprises five main sections: 

ü  UK physical activity guidelines

ü  Health benefits - for 33 different medical conditions

ü  Motivation – using two different methods

ü  Starting to exercise

ü  Resource section of further information and

     practical tools.

With downloadable and printable resources for both professionals and patients, short instructional videos and case studies the website covers all aspects of exercise and health from general recommendations to disease specific information.

If ever there was a time that called for urgent change in how we promote increased physical activity and a healthy lifestyle it is NOW. This package gives GPs the tools to overcome many of the barriers and spending time on it would be a very valuable use of your CPD time.

Brian Johnson MBCHB, MRCGP, MFSEM,

Honorary Medical Advisor for Public Health Wales

 

Reference

1. Hebert ET, O Caughy M, Shuval; BJSM 2012;46:625-631

 other references available on request and on the Motivate 2 Move  site

 

 

Impact of the NB Medical ‘Hot Topics’ GP Update Course

It is often quoted in the medical literature that traditional medical CME is ineffective in achieving ‘knowledge translation’ i.e. translating clinical research findings into changes in practice. Implementation Science2012;7:50

We challenge that view with our Hot Topics GP Update course. Having received many emails over the years from delegates telling us how the course had changed their practice, in 2013 we surveyed our delegates to assess the impact of their learning.

We sent a ‘Survey Monkey’ questionnaire to 3,854 delegates 6 weeks after attending the course in April 2013. 844 answered (22% response rate)

·         97% of delegates have changed practice as a result of new knowledge gained on the course

·         72% of delegates use the material at least weekly to find evidence-based answers to clinical problems

·         70% had already used the material for their own in-house training and teaching

·         24% had already completed a personal audit based on an idea from the course

 
We repeated the survey 6 months after attending the course, 200 delegates responded (5% of all delegates).

·         93% of respondents had maintained a change in practice at 6 months

 

How have GPs changed practice following the course?

We have over 800 examples on file of how practice has changed as a result of the course.  See below for some examples.

 

Conclusion: our data confirms our view that a high quality, independent 'traditional' medical course enthusiastically delivered to GPs with quality supporting materials can change practice and leads to meaningful quality improvements for patients, which are maintained at 6 months.

 

Simon Curtis FRCGP

Medical Director NB Medical Education

scurtis@nbmedical.com

Some example responses from delegates (over 800 on file, available on request) as to how they have changed practice include:

·         Prompted the formation of a register and the start of health checks for patients with a learning disability in the practice.

·         I now usually check urine samples in children with a fever before saying the cause is viral.

·         Cancer diagnosis - have researched RAT/Qcancer and has improved my management of suspicious cases especially those not fulfilling 2WW criteria

·         Lifestyle questionnaire for mental health QOF, elderly and poly pharmacy, multiple disease registers looking at managing better

·         I developed a template in the practice for management of paediatric constipation

·         Our prevalence of AF is lower that it should be and we have tried to look at a simple way to pick up more patients. We are going to check pulse rhythm and rate in every patient coming in for influenza vaccine this autumn.

·         checking urine in everyone with anaemia

·         reduced my prescription of antibiotics

·         Oh there are so many. I found the section on GCA and PMR v useful and has changed the way I managed 2 patients.

·         I did an audit to see how many patients were co-prescribed tamoxifen and paroxetine/ fluoxetine. I changed their antidepressents. It would be terrible after a woman’s fight with breast cancer for me to give something that would make her tamoxifen work less. There were 3 patients in my Practice. I educated the rest of the team and have re-audited recently. Now there are no patients being co-prescribed these medications

·         We are trying to bring patients with multiple morbidity to one clinic rather than separate clinics

·         Development of diagnosis support tool for vertigo and recommending the booklet balance retraining which hopefully will reduce some of our ENT referrals

Reasons to be cheerful for 2014

Happy New Year! 

Best to put 2013 behind us.  It was a hard year for the profession.  There was a constant barrage of negativity laid down by politicians and the media – paid too much, working too little and responsible for many of the ailments eroding the NHS. 

Of course none of these is true.  But negativity sells papers and allows politicians to undermine and further their own murky agendas.

But 2014 is upon us and it is time for a change.  So turn off the TV, throw that newspaper on the fire and, for the love of God, don’t go on any internet forums because there are reasons to be positive!

Patients actually still like us and value what we do.

Did you get a card or a present from a patient this Christmas?  I bet you did.  Is this the action of people that despise the profession?  Of course not.  Regardless of the rubbish you may read in the paper, the vast majority of people appreciate the work we do and believe we are good at it.

The latest GP Patient Survey shows exactly that.  Published in December 2013, 92% of patients had confidence and trust in their GP.  Despite a year of overwhelming negativity, when you ask the people that we help day in day out, the people that really matter, you get a positive reply.

Less bureaucracy

With around a third of QOF dropped for the 2013/14 contract (in England at least, with the rest of the UK likely to follow in time) and many onerous tasks such as QP shelved, there is a swing back to patient contact rather than computer contact.  While getting a feel for what will be necessary is going to take time, this feels like a step in the right direction.

Our skills are more vital than ever.

Over the past decade we have seen the rise of the guideline.  Evidence-based medicine has become, quite rightly, the benchmark of good clinical practice, but has been often misappropriated by the establishment, particularly through QOF.  Too long have we been shackled to guidelines.

We should never forget that evidence-based medicine is about using the best available evidence together with our own experience and that of our patient to address a problem.  Nothing in primary care is ever black and white.  No guideline should be blindly followed.

The growing recognition of multimorbidity and polypharmacy (which we will cover on the Spring Hot Topics course) herald the emancipation of our profession.  Patients with multiple chronic diseases are the norm and a growing body of research explains that a one-size-fits-all approach will not work.

But more research cannot give us all the answers.  As one delegate pointed out last year: “I feel sad that this even needs to be researched.  This is our job.”  No study will ever be able to usefully address the endless permutations of patients with different conditions, different medications, different lives – which is why our experience and skill is vital to work out what is best for that person and can never be replaced.

Thinking positively
Anyone who has ever done Mindfulness will know that by simply smiling we feel better.  It’s a cheap trick but it works.   So, let’s not focus on the negatives – focus on the good bits.  Once we are positive about ourselves then we, our staff and our patients will start to feel good about what remains a great profession.  I for one am glad to be a GP.

Neal