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Developing counselling practices in physical
          activity by tutoring multi-professional
                 teamwork in primary care
Marjo Rinne, D.Sc, 1
Erja Toropainen, M.Sc 1
Minna Aittasalo D.Sc 1,
Tommi Vasankari, D.Med.Sci 1,
Katriina Kukkonen-Harjula, D.Med.Sci 1,2

1 The UKK Institute for Health
Promotion Research Tampere
2 University of Eastern Finland, Kuopio
Finland

marjo.rinne@uta.fi




  Introduction
   Physical Activity Prescription (PAP) has been proven feasible
   and effective in routine health care practices.
   (Aittasalo et al. 2006, Aittasalo et al. 2007)

   However, local efforts are needed to facilitate its adoption
   in primary health care services.




          Physical Activity Prescription Program (PAPP) 2001-2004
    Marjo Rinne, Turku 24.-26.8.2011




                                                                    1
5 A´s FRAMEWORK
                                            Assess and Advise
                                            -physical activity level
                                            -physical abilities
                                            -beliefs and knowledge
                                            -Health risks, benefits of change



                                            Agree and Assist
                                            -Collaboratively developed
                                            personalized action plan
                                            -Identify personal barriers and
                                            strategies


                                             Arrange
                                             - Plan for follow-up
                                                               Estabrooks et al. 2003

    Marjo Rinne, Turku 24.-26.8.2011




  Ongoing actions in Finland

  continuous training
  integration of PAP to national patient record system
  updating of PAP material according to recent recommendations
  producing all material in various electronic formats
  linking PA and PAP to all relevant clinical guidelines
  development of dissemination protocol and supportive material for
health care units



    Marjo Rinne, Turku 24.-26.8.2011




                                                                                        2
Intervention to improve PA counseling practices,
uptake of PAP and collaboration

Aims are

• to increase knowledge about PA, counselling and PAP,

• to improve counselling practices and adoption of PAP,

• to enhance counselling collaboration among health care and
  exercise professionals, and

• to develop electric documentation of PA counselling in
  patient records.

 Marjo Rinne, Turku 24.-26.8.2011




Implementation
In four municipal health centres in Pirkanmaa region, Finland


A multi-professional team selected in each health centre is
responsible for carrying out the 6-month study.

Teams select target groups and actions.


The professionals in health care have received supportive PAP
material (electronic Physical Activity Prescription, User s Guide for PAP,
                                                         ´
                                                         ´
                                                         ´
                                                         ´
Rated Perceived Exertion (RPE) Scale, electronic follow-up description)


 Marjo Rinne, Turku 24.-26.8.2011




                                                                             3
Double-
sided
User’s
Guide




  Marjo Rinne, Turku 24.-26.8.2011




 Implementation

  The actions of the responsible teams are tutored for 6 month
  with 4 goal-oriented meetings.


  After tutoring process a conclusive meeting will be held.


  The study will last until February 2012.


  The preliminary experiences are positive.



  Marjo Rinne, Turku 24.-26.8.2011




                                                                 4
Evaluation at baseline and after the intervention:
1)   Self-administered questionnaire to the professionals:
•    attitudes, knowledge, current counseling,
•    use of written PAP,
•    documentation of PA counseling,
•    collaboration

2) Professionals’ 5-day logbooks after the patient visits:
• bringing out the contents of counselling PA,
• implementing PA counseling,
• use of PAP during patient appointments,
• documentation of PA to the patient record system


 Marjo Rinne, Turku 24.-26.8.2011




Evaluation at baseline and after the intervention:


3) Self-administered questionnaire to the patients:
• discussion about PA,
• occurrence of PA counseling,
• delivery of PA prescription etc.

4) Telephone interview of municipal exercise service
   providers:
   to most important collaborators in exercise sector are used
   to evaluate collaboration with health care.



 Marjo Rinne, Turku 24.-26.8.2011




                                                                 5
Evaluation at baseline and after the intervention:


5) A sample of patient documentation from the patient record
   system:
• documentation of PA counseling

6) Process evaluation is based on
• the meeting minutes of the responsible teams and
• tutor meetings to explain underlying factors promoting or
   preventing the process of change.



Marjo Rinne, Turku 24.-26.8.2011




 Conclusion

 The intervention produces one approach to improve
 volume and quality of counselling in primary health care.


 If the results are positive, they may be applied
 to other similar kind of processes, e.g. nutrition.




Marjo Rinne, Turku 24.-26.8.2011




                                                               6
Physicians start to write physical
       activity prescriptions




     Unfortunately we do not have these as pills, you have to do these
     exercises by yourself.
Marjo Rinne, Turku 24.-26.8.2011




                                                                         7

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Nfhk2011 rinne parallel25

  • 1. Developing counselling practices in physical activity by tutoring multi-professional teamwork in primary care Marjo Rinne, D.Sc, 1 Erja Toropainen, M.Sc 1 Minna Aittasalo D.Sc 1, Tommi Vasankari, D.Med.Sci 1, Katriina Kukkonen-Harjula, D.Med.Sci 1,2 1 The UKK Institute for Health Promotion Research Tampere 2 University of Eastern Finland, Kuopio Finland marjo.rinne@uta.fi Introduction Physical Activity Prescription (PAP) has been proven feasible and effective in routine health care practices. (Aittasalo et al. 2006, Aittasalo et al. 2007) However, local efforts are needed to facilitate its adoption in primary health care services. Physical Activity Prescription Program (PAPP) 2001-2004 Marjo Rinne, Turku 24.-26.8.2011 1
  • 2. 5 A´s FRAMEWORK Assess and Advise -physical activity level -physical abilities -beliefs and knowledge -Health risks, benefits of change Agree and Assist -Collaboratively developed personalized action plan -Identify personal barriers and strategies Arrange - Plan for follow-up Estabrooks et al. 2003 Marjo Rinne, Turku 24.-26.8.2011 Ongoing actions in Finland continuous training integration of PAP to national patient record system updating of PAP material according to recent recommendations producing all material in various electronic formats linking PA and PAP to all relevant clinical guidelines development of dissemination protocol and supportive material for health care units Marjo Rinne, Turku 24.-26.8.2011 2
  • 3. Intervention to improve PA counseling practices, uptake of PAP and collaboration Aims are • to increase knowledge about PA, counselling and PAP, • to improve counselling practices and adoption of PAP, • to enhance counselling collaboration among health care and exercise professionals, and • to develop electric documentation of PA counselling in patient records. Marjo Rinne, Turku 24.-26.8.2011 Implementation In four municipal health centres in Pirkanmaa region, Finland A multi-professional team selected in each health centre is responsible for carrying out the 6-month study. Teams select target groups and actions. The professionals in health care have received supportive PAP material (electronic Physical Activity Prescription, User s Guide for PAP, ´ ´ ´ ´ Rated Perceived Exertion (RPE) Scale, electronic follow-up description) Marjo Rinne, Turku 24.-26.8.2011 3
  • 4. Double- sided User’s Guide Marjo Rinne, Turku 24.-26.8.2011 Implementation The actions of the responsible teams are tutored for 6 month with 4 goal-oriented meetings. After tutoring process a conclusive meeting will be held. The study will last until February 2012. The preliminary experiences are positive. Marjo Rinne, Turku 24.-26.8.2011 4
  • 5. Evaluation at baseline and after the intervention: 1) Self-administered questionnaire to the professionals: • attitudes, knowledge, current counseling, • use of written PAP, • documentation of PA counseling, • collaboration 2) Professionals’ 5-day logbooks after the patient visits: • bringing out the contents of counselling PA, • implementing PA counseling, • use of PAP during patient appointments, • documentation of PA to the patient record system Marjo Rinne, Turku 24.-26.8.2011 Evaluation at baseline and after the intervention: 3) Self-administered questionnaire to the patients: • discussion about PA, • occurrence of PA counseling, • delivery of PA prescription etc. 4) Telephone interview of municipal exercise service providers: to most important collaborators in exercise sector are used to evaluate collaboration with health care. Marjo Rinne, Turku 24.-26.8.2011 5
  • 6. Evaluation at baseline and after the intervention: 5) A sample of patient documentation from the patient record system: • documentation of PA counseling 6) Process evaluation is based on • the meeting minutes of the responsible teams and • tutor meetings to explain underlying factors promoting or preventing the process of change. Marjo Rinne, Turku 24.-26.8.2011 Conclusion The intervention produces one approach to improve volume and quality of counselling in primary health care. If the results are positive, they may be applied to other similar kind of processes, e.g. nutrition. Marjo Rinne, Turku 24.-26.8.2011 6
  • 7. Physicians start to write physical activity prescriptions Unfortunately we do not have these as pills, you have to do these exercises by yourself. Marjo Rinne, Turku 24.-26.8.2011 7