Implementing Individually Tailored Prescription of Physical Activity in Routine Clinical Care: A Process Evaluation of the Physicians Implement Exercise = Medicine Project

Author:

Bouma Adrie J.1,Nauta Joske2,van Nassau Femke2,Krops Leonie A.1,van den Akker-Scheek Inge3,Diercks Ron L.3,de Groot Vincent4,van der Leeden Marike4,Leutscher Hans5,Stevens Martin3,van Twillert Sacha6,Zwerver Hans78,van der Woude Lucas H.V.7,van Mechelen Willem27,Verhagen Evert A.L.M.2,van Keeken Helco G.7,van der Ploeg Hidde P.2,Dekker Rienk1,_ _

Affiliation:

1. Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

2. Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

3. Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

4. Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

5. Knowledge Centre for Sport and Physical Activity, Ede, The Netherlands

6. UMC Staff Policy and Management Support, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

7. Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

8. Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands

Abstract

Background: Although the prescription of physical activity in clinical care has been advocated worldwide, in the Netherlands, “Exercise is Medicine” (E = M) is not yet routinely implemented in clinical care. Methods: A set of implementation strategies was pilot implemented to test its feasibility for use in routine care by clinicians in 2 departments of a university medical center. An extensive learning process evaluation was performed, using structured mixed methods methodology, in accordance with the Reach, Effect, Adoption, Implementation, and Maintenance framework. Results: From 5 implementation strategies employed (education, E = M tool embedded in the electronic medical records, lifestyle coach situated within the department, overviews of referral options, and project support), the presence of adequate project support was a strong facilitator of the implementation of E = M. Also, the presence of the lifestyle coach within the department seemed essential for referral rate. Although clinicians appreciated the E = M tool, barriers hampered its use in practice. Conclusions: Specific implementation strategies, tailored to the setting, are effective in facilitating the implementation of E = M with specific regard to education for clinicians on E = M, deployment of a lifestyle coach within a department, and project coordination. Care providers do see a future for lifestyle coaches who are structurally embedded in the hospital, to whom they can easily refer.

Publisher

Human Kinetics

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