This study was embedded in the Check-In randomised controlled trial that investigated the effectiveness of general practice-based preventive health checks on adverse health behaviour and early detection of non-communicable diseases offered to individuals with low socioeconomic positions. Despite successful recruitment of patients, the intervention had no effect. One reason for the lack of effectiveness could be low rates of referral to behaviour-change programmes in the municipality, resulting in a low dose of the intervention delivered. The aim of this study is to examine the referral pattern of the general practitioners and potential barriers to referring eligible patients to these behaviour-change programmes. A mixed-method design was used, including patients’ questionnaires, recording sheet from the health checks and semi-structured qualitative interviews with general practitioners. All data used in the study were collected during the time of the intervention. Logistic regressions were used to estimate odds ratios for being eligible and for receiving referrals. The qualitative empirical material was analysed thematically. Emerging themes were grouped, discussed and the material was re-read. The themes were reviewed alongside the analysis of the quantitative material to refine and discuss the themes. Of the 364 patients, who attended the health check, 165 (45%) were marked as eligible for a referral to behaviour-change programme by their general practitioner and of these, 90 (55%) received referrals. Daily smoking (OR = 3.22; 95% CI:2.01–5.17), high-risk alcohol consumption (OR = 2.66; 95% CI:1.38–5.12), obesity (OR = 2.89; 95% CI:1.61–5.16) and poor lung function (OR = 2.05; 95% CI:1.14–3.70) were all significantly associated with being eligible, but not with receiving referral. Four themes emerged as the main barriers to referring patients to behaviour-change programmes: 1) general practitioners’ responsibility and ownership for their patients, 2) balancing information and accepting a rejection, 3) assessment of the right time for behavioural change and 4) general practitioners’ attitudes towards behaviour-change programmes in the municipality. We identified important barriers among the general practitioners which influenced whether the patients received referrals to behaviour-change programmes in the municipality and thereby influenced the dose of intervention delivered in Check-In. The findings suggest that an effort is needed to assist the collaboration between general practices and the municipalities’ primary preventive services. Clinical Trials NCT01979107 ; October 25, 2013.

中文翻译：

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为什么全科医师在进行预防性健康检查后不将患者转诊至行为改变计划？混合方法研究

这项研究被纳入了“登记入住”随机对照试验中，该试验研究了基于一般实践的预防性健康检查对不良健康行为以及为社会经济地位低下的人提供的非传染性疾病的早期发现的有效性。尽管成功招募了患者，但干预措施没有效果。缺乏有效性的原因之一可能是市政当局对行为改变计划的推荐率低，从而导致干预措施的剂量低。这项研究的目的是检查全科医生的转诊模式以及将合格患者转诊至这些行为改变计划的潜在障碍。使用了一种混合方法设计，包括患者的问卷调查，健康检查的记录表以及对全科医生的半结构化定性访谈。在干预期间收集了研究中使用的所有数据。使用Logistic回归来估算符合条件和接受推荐的赔率。对定性的经验材料进行了主题分析。对新兴主题进行了分组，讨论和重新阅读了材料。主题与定量材料分析一起进行了审查，以完善和讨论主题。在参加健康检查的364位患者中，有165位（45％）被其全科医生标记为有资格转诊为行为改变计划，其中90位（55％）得到了转诊。每天吸烟（OR = 3.22； 95％CI：2.01-5.17），高危饮酒（OR = 2.66； 95％CI：1.38–5.12），肥胖（OR = 2.89； 95％CI：1.61-5.16）和肺功能不佳（OR = 2.05； 95％CI：1.14-3.70）均与合格率显着相关，但与接受转诊无关。出现了四个主题，这是将患者转为行为改变计划的主要障碍：1）全科医生对其患者的责任和所有权； 2）平衡信息并接受拒绝； 3）评估正确的时间以改变行为；以及4）全科医生对市政部门的行为改变计划的态度。我们在全科医生中发现了重要的障碍，这些障碍影响了患者是否在市政上接受了转诊行为改变计划的咨询，从而影响了Check-In进行干预的剂量。调查结果表明，需要做出努力，以协助一般做法与市政当局的主要预防服务之间的协作。临床试验NCT01979107; 2013年10月25日。