Lifestyle Interventions in Medecine

Evaluation of the implementation of Group medical visits in primary care

Description and Objectives

• To identify the elements that need to be integrated to promote the effectiveness of group medical visits (GMV)
• To evaluate the implementation of GMV in a clinic offering primary care.

There is ample evidence that strengthening the primary healthcare system could improve the health status of the population, particularly among people with chronic diseases. Group medical visits (GMVs) can help overcome several of these barriers and effectively improve clinical indicators as well as patients’ quality of life. GMVs could also reduce pressure on the healthcare system by improving access to primary care through a more efficient use of ressources.

Methods: For Objective 1, we will conduct a systematic review of the literature to identify the health conditions for which sufficient evidence exists to support the deployment of VMG and others for which clinical studies are required. Through this literature review, we also aim to list the implementation conditions to be considered in order to maximise the chances of success of VMGs. For Objective 2, we will use the RE-AIM reference framework to evaluate the implementation of VMG at the Dieppe Family Medicine Unit clinic.

Importance of the project: At the beginning of 2024, our team hosted a province-wide Open Forum inviting the community to explore innovative solutions for leveraging lifestyle habits in primary healthcare settings. This project demonstrates our responsiveness to community needs, as it aligns with the ideas proposed during the forum (to normalize healthy lifestyle behaviours; to use primary healthcare professionals as champions for promoting healthy lifestyles; to use novel intervention approaches to integrate lifestyle education as part of primary healthcare). Moreover, this proposal will enable us to position ourselves for larger-scale projects, including longitudinal cohort studies.

Prescribing physical activity during pregnancy

Description and Objectives

Although most doctors recognize that physical activity is associated with numerous therapeutic benefits, only a relatively small number prescribe it. Studies that fall under this research problem aim to:

• Identify ways in which to include physical activity prescription into the regular practice of family physicians, and
• Evaluate the intervention effects of promoting and prescribing physical activity in clinical care units

One of our main research projets under this theme tests the effects of a physical activity promoting intervention during pregnancy on maternal and fetal outcomes. Although it is generally known that physical activity is associated with the prevention of excessive gestational weight gain (GWG), gestational diabetes (GD), gestational hypertension (GHT) and macrosomia, fewer than two in ten Canadian women meet the physical activity recommendation during pregnancy. For a pilot study, we aimed to examine the effect of a physical activity promoting intervention during pregnancy on GWG, GD, GHT and fetal macrosomia.

Methods: Two groups of pregnant women who had their pregnancy follow-ups at the Obstetrics Clinic of the Dr. Georges-L.-Dumont University Hospital Centre (DGLDUHC) in Moncton, Canada, were formed. The group exposed to the intervention received standard follow-up supplemented with physical activity education during pregnancy from a nurse accompanied by a physical activity prescription from a doctor. The comparison group received standard care. Respectively, 422 and 394 women were included in the analysis of data from the intervention and comparison groups. outcomes among women in the two study groups.

Results: The intervention was associated with a 29% reduction in the odds of developing GWG, a 73% reduction in the odds of developing GHT and a 44% reduction in the odds of macrosomia. The intervention was not associated with a reduced odds of developing GD.  The intervention was adopted and implemented by 100% of nurses and 71% of physicians. Women with pregnancies during the intervention-period perceived the intervention positively.

Conclusion: A combination of education about the appropriateness of physical activity and a physical activity prescription is an intervention to be considered in routine maternity care to reduce the risk of pregnancy complications. Although it has a high effectiveness potential, this new low-cost intervention is simple to implement.

For more information on this study, you can consult the following article:  Saidi L, Godbout PD, Morais-Savoie C, Registe PPW, Bélanger M. Association between physical activity education and prescription during prenatal care and maternal and fetal health outcomes: a quasi-experimental study. BMC Pregnancy Childbirth. 2023 Jul 5;23(1):496. doi: 10.1186/s12884-023-05808-x. PMID: 37407926; PMCID: PMC10320878.