How do general practitioners provide physical activity advice during consultations with patients?

Problem

Physical inactivity contributes significantly to the burden of non-communicable disease. The Royal College of General Practitioners Clinical Priority Programme highlights the key role of general practitioners (GPs) in promoting physical activity (PA) through frequent patient contact. Surveys indicate GPs lack confidence and training in PA advice. Any opportunistic PA intervention must be brief, feasible and acceptable within the competing demands of short consultations.

An understanding of how PA advice is currently delivered in consultations, including missed opportunities, is important for any future intervention development. Given the limitations of routinely recorded data from medical records, video-recorded consultations offer one approach to research doctor-patient interactions.

This study aims to explore and describe physical activity advice and missed opportunities, within video-recorded GP-patient consultations.

Approach

The ‘One in a Million’ prospective observational study provides a unique data archive of 300 video recorded consultations at 12 different surgeries and 22 GPs. These video transcripts were therefore screened to identify videoed consultations where PA advice was delivered to patients or where there were missed opportunities for physical activity advice. Missed opportunities were deemed to be consultations where there was an opportunity for a proactive lifestyle intervention or where PA was a recognised evidence-based recommendation for a particular presenting complaint or long-term condition. A second author screened a stratified random sample of 46 consultations which informed a quality assurance protocol.

The PA content delivered in the consultations was assessed using ‘Moving Medicine’ a resource developed by the Faculty of Sports and Exercise Medicine and key stakeholders, and relevant national PA and clinical guidelines. The quality of the consultations was assessed using the Global Consultation Rating Scale; used in studies assessing video recorded consultations.

Findings

Preliminary results show that any PA advice given tends to be covered superficially and largely without specific tailored guidance or planned review. Missed opportunities were identified for both lifestyle health promotion opportunities and chronic health disease management.

Consequences

Well-delivered PA advice can be a cornerstone in strategies to improve population health through general practice. Whilst this cross-sectional study design does not account for PA discussions which may have taken place in previous consultations, it demonstrates opportunities for improvement in PA advice given to patients in GP consultations and the need for a continual proactive opportunistic PA dialogue with patients for lifestyle intervention and as part of long-term disease management.

Future work should develop and evaluate very brief physical activity interventions that can readily be adopted by GPs and trainees, in parallel with strategies to develop the skills and confidence to enable a cultural shift in PA advice.