Exercise promotion and fall prevention in the GP surgery

Objective / Description

Practice nurses working in GP surgeries were targeted for training on how to counsel older patients on physical activity enhancement.

Procedure

GPs and their practice nurses were identified as potential ambassadors. Since most GPs are reluctant to expand their service to physical activity counseling we primarily addressed practice nurses for training. The project comprised of two steps: 1) First, we needed to persuade GPs to participate and act as a bridge to their patients. 2) The second step was to train practice nurses to assess patients and to refer them suitable exercise.

Main contents of the course were:

• How to undertake a physical performance test following the National Initiative for Fall Prevention (Bundesinitiative Sturzprävention) model
• Knowledge on how to offer suitable exercise groups and classes based on physical performance test results.

Ad 1) All local physicians were invited to a presentation of the project at their local medical council. Fundamental aspects of fall prevention were presented by project members with a focus on their relation to general practice. Attending practice nurses were offered training in how to perform physical performance tests (5-Chair Rise Test, balance test, gait speed and Timed-up-and-go test). They were given printed material with exact description on how to perform these tests and how to interpret and document the results.

Ad 2) The course was designed for practice nurses working in the project region. It was held in an IT-training unit at the local community college. Case studies were presented to exemplify how individuals may be counseled on how to enhance their physical activity. Course participants were trained in how to use this information alongside the web-based registry of all physical activity courses and exercise classes. Rehabilitation sports classes were also presented. These disease-specific exercise classes (e.g. cardio rehabilitation, exercise after cancer) are specific to the German health care system and are offered by sports clubs, prescribed by physicians, and reimbursed by the health care insurance. Furthermore, prescription of the Otago exercise program was integrated in the cases.

Stakeholders and their tasks

Project members: Execution of both training courses

Ad 1) local medical council: inviting all surgeries, providing space

Ad 2) local physician network: inviting members

Material

Ad 1.) PowerPoint presentation and print material with exact description on how to accomplish these tests and how to interpret and document the tests.

Ad 2.) PowerPoint presentation and cases with potential patients needing counseling on physical activity enhancement.

Expenses / Time

• Logistics and preparation: around 8 hours
• Duration each session: 90 minutes
• Hire of IT-training unit

Results

Ad 1) Around 40 GPs and practice nurses attended. Practice nurses expressed great interest in undertaking physical performance tests.

Ad 2) 16 practice nurses participated. There was no evaluation of their success in daily routine.

Experiences / Advice

Ad 1) Through the initial presentation interested GP surgeries could be identified. There were mixed responses on the feasibility of physical performance tests in GP surgeries.

Ad 2) There was an interested and attentive atmosphere throughout the course. The practice nurses had fun working on cases and there was lively discussion of cases. However, we assume that there was some selection bias amongst the practice nurses with those attending having an understanding of the role of health promotion and/or who are interested in expanding their potential duties by offering health promotion.