title: Putting prevention into practice: qualitative study of factors that inhibit and promote preventive care by general practitioners, with a focus on elderly patients.
abstract: BACKGROUND
  General practitioners (GPs) have a key role in providing preventive care, particularly for elderly patients. However, various factors can inhibit or promote the implementation of preventive care. In the present study, we identified and examined factors that inhibit and promote preventive care by German GPs, particularly for elderly patients, and assessed changes in physicians' attitudes toward preventive care throughout their careers.
  
  
  METHODS
  A qualitative, explorative design was used to identify inhibitors and promoters of preventive care in German general medical practice. A total of 32 GPs in Berlin and Hannover were surveyed. Questions about factors that promote or inhibit implementation of preventive care and changes in physicians' perceptions of promoting and inhibiting factors throughout their careers were identified. Episodic interviews, which encouraged the reporting of anecdotes regarding daily knowledge and experiences, were analyzed using ATLAS/ti. Socio-demographic data of GPs and structural information about their offices were collected using short questionnaires. The factors identified as inhibitory or promoting were classified as being related to patients, physicians, or the healthcare system. The changes in GP attitudes toward preventive care throughout their careers were classified as personal transitions or as social and health policy transitions.
  
  
  RESULTS
  Most of the identified barriers to preventive care were related to patients, such as a lack of motivation for making lifestyle changes and a lack of willingness to pay for preventive interventions. In addition, the healthcare system seemed to inadequately promote preventive care, mainly due to poor reimbursement for preventive care and fragmentation of care. GPs own attitudes and health habits seemed to influence the implementation of preventive care. GPs recognized their own lack of awareness of effective preventive interventions, particularly for elderly patients. GPs were motivated by positive preventive experiences, but often lacked the necessary training to counsel and support their patients.
  
  
  CONCLUSIONS
  German GPs had positive attitudes towards prevention, but the implementation of preventive care was neither systematic nor continuous. Identification and elimination of barriers to preventive care is crucial. Further research is needed to identify effective practice-based approaches to overcome these barriers.
authors.affiliation: Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Carl-Neuberg Strasse 1, OE 5410, 30623 Hannover, Germany. walter.ulla@mh-hannover.de
authors.forename: Ulla
authors.initials: U
authors.lastname: Walter
authors.forename: Uwe
authors.initials: U
authors.lastname: Flick
authors.forename: Anke
authors.initials: A
authors.lastname: Neuber
authors.forename: Claudia
authors.initials: C
authors.lastname: Fischer
authors.forename: Rugzan J
authors.initials: RJ
authors.lastname: Hussein
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D005858:Germany; D006293:Health Promotion; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology*; D011314:Preventive Health Services