Developing counselling practices in physical activity by tutoring multi-professional teamwork in primary care UKK Institut, Finland 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

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
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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
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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,
´
´
´
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Rated Perceived Exertion (RPE) Scale, electronic follow-up description)
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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.
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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.
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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.
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7. Physicians start to write physical
activity prescriptions
Unfortunately we do not have these as pills, you have to do these
exercises by yourself.
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