About OptiCor

question-mark2

What is the scientific background of OptiCor?

Chronic ischemic heart disease is the leading cause of morbidity and mortality in Germany and presents a heavy burden for society. Besides drug and surgical therapy, regular physical activity is an essential secondary preventive measure in the management of ischemic heart disease. However, most patients do not achieve clinical guidelines or the World Health Organization recommendations for physical activity levels. In fact, every other patient with ischemic heart disease in Germany is not physically active at all.

Brief advice from general practitioners on physical activity has shown to increase patients’ physical activity levels. The “National Health Care Guideline on chronic ischemic heart disease” (Nationale VersorgungsLeitlinie Chronische koronare Herzkrankheit) strongly recommends that general practitioners offer their patients brief advice on increasing their physical activity. These recommendations seem insufficiently implemented for a number of reasons. One explanation is that physicians are not adequately trained to counsel their patients effectively and efficiently on behaviour change. International guidelines recommend that physicians should be trained to provide brief and target-group-specific advice on physical activity. Currently, in Germany, appropriate training in medical education is lacking and most brief counselling approaches are still too time consuming for routine implementation in general practice. The evidence is missing about whether such training can effectively increase the rates of brief advice on physical activity delivered by general practitioners during routine consultation with patients with ischemic heart disease.

The junior research group „OptiCor – Optimising the treatment of chronic ischemic heart disease by training general practitioners to deliver very brief advice on physical activity” is focussing on this topic. The study has been funded by the German Federal Ministry of Education and Research since 2022.

target2

What is the aim of the OptiCor study?

As a strategy to improve healthcare of patients with ischemic heart disease, the OptiCor study aims to develop and evaluate a single training for general practitioners to deliver very brief advice on physical activity in patients with ischemic heart disease (complex intervention study).

footprint2

How is the OptiCor study implemented?

The study is compromised of three work phases which will be conducted over a period of five years:

1) An analysis of needs including the systematic development of the intervention and preparatory work for a potential future implementation, 2) piloting of the intervention, and 3) an evaluation study. This design is based on the recommendations of the „Medical Research Council framework for developing and evaluating complex interventions (MRC Framework).“

Methods

The study consists of six work packages that will be implemented during the three work phases:

Phase 1: Analysis of needs and development of the intervention (study years 1-2)

Work package 1 (quantitative research methods): For the first step, a Germany-wide cross-sectional survey of ~1,000 persons with ischemic heart disease will be conducted. The aim of the survey is to collect current and representative information from persons with self-reported ischemic heart disease about the previous receipt of advice on physical activity delivered by a general practitioner, as well as their needs and expectations in this regard. In addition, potential associations between the previous receipt of such advice and specific person characteristics will be explored.

Work package 2 (qualitative research methods): In-depth problem-centred interviews and focus groups will be conducted with patients with ischemic heart disease and general practitioners. The qualitative study aims to explore personal attitudes, experiences, and needs of general practitioners and patients with ischemic heart disease regarding physical activity counselling. Motivators, barriers and supporting factors for implementation of routinely delivered advice on increasing physical activity by general practitioners will be identified. In addition, requirements for appropriate training for general practitioners will be collected.

Work package 3 (systematic development of the intervention): Based on WP1 and WP2, a theory-based, brief, single, tailored general practitioner training will be developed to deliver brief advice on physical activity effectively and efficiently during routine consultations with patients with ischemic heart disease. The development of the intervention will be conducted in a multi-professional team together with patient representatives, general practitioners, and experts in behavioural change, health services and public health research.

Work package 4 (health economic and qualitative research methods): In order to facilitate a health economic evaluation of a future broad implementation study, accompanying health economic research will be conducted throughout the project. For this purpose, a Discrete Choice Experiment on patient-related outcome preferences will be developed and piloted. In addition, a quantitative survey on health care utilisation among patients with ischemic heart disease will be developed and pilot tested.


Study materials of work package 1 and 2 (e.g., questionnaires, focus group and interview guidelines) are published on Open Science Framework: https://osf.io/v2h6d/

Phase 2: Pilot study (study years 2-3)

Work package 5 (pilot study): As a next step, a pragmatic cluster randomised controlled trial (cRCT) on the effectiveness of the developed training (see WP 3) on patient-reported rates of brief advice on increasing physical activity delivered by general practitioners during routine care of patients with ischemic heart disease (primary outcome) will be designed and piloted.

Phase 3: Evaluation study (study years 4-5)

Work package 6 (cRCT): In a full pragmatic cRCT – including approximately 50 general practitioner practices and 600 patients with ischemic heart disease – the effectiveness of the developed training for general practitioners will be evaluated. Furthermore, the cRCT will be accompanied by a process evaluation.  The aim of WP6 is to explore whether the training is an effective strategy to make advice on physical activity more feasible for general practitioners and more acceptable for patients with ischemic heart disease; and thus, to increase rates and quality of delivered advice for physical activity. If so, approaches will be developed and tested to make the training accessible to a large number of general practitioners.

Publications

Publications/Publikationen

Kastaun S, Prinz A, Hoppe S, Gabrys L, Wilm S. Beratung zu Bewegung in der Hausarztpraxis [Advice on physical activity in general practice]. Zeitschrift für Allgemeinmedizin. 2024. DOI: 10.1007/s44266-023-00166-5

Hoppe S, Prinz A, Crutzen R, Donner-Banzhoff N, Icks A, Kotz D, Kuß O, Mons U, Vomhof M, Wilm S, Kastaun S. Optimising the treatment of chronic ischemic heart disease by training general practitioners to deliver very brief advice on physical activity (OptiCor): protocol of the systematic development and evaluation of a complex intervention [Internet]. Research Square [Preprint]. 2023. Available from: https://doi.org/10.21203/rs.3.rs-3453073/v1.

Lectures/Vorträge

Hoppe S, Kotz D, Mons U, Prinz A, Kastaun S. Hausärztliche Beratung zu Bewegung bei koronarer Herzkrankheit: Eine deutschlandweite Querschnittstudie (OptiCor Studie, BMBF  Nachwuchsgruppe Versorgungsforschung) [Abstract]. Vortrag auf dem 22. Deutschen Kongress für Versorgungsforschung (DKVF) [General practitioners‘ advice on exercise of people with ischemic heart disease: a cross-sectional study in Germany (OptiCor Study, BMBF Junior Research Group on Health Services Research) [Abstract]. Presentation at the 22nd German Congress on Health Services Research (DKVF)]. Berlin, 04.-06.10.2023. DOI: https://dx.doi.org/10.3205/23dkvf514

Prinz A, Leve V, Gummersbach E, Wilm S, Hoppe S, Vogl F, Kirchhof U, Neuhaus A, Kastaun S. Beratung zu Bewegung in der hausärztlichen Versorgung von Menschen mit koronarer Herzkrankheit –  eine qualitative Studie zu Erfahrungen, Einstellungen und Bedarfen von  Hausärzt:innen (OptiCor Studie, BMBF Nachwuchsgruppe  Versorgungsforschung) [Abstract]. Vortrag auf dem 22. Deutschen Kongress für Versorgungsforschung (DKVF) [Advice on exercise in primary care of people with ischemic heart disease – a qualitative study on experiences, attitudes and needs of general practitioners (OptiCor Study, BMBF Junior Research Group on Health Services Research) [Abstract]. Presentation at the 22nd German Congress on Health Services Research (DKVF)]. Berlin, 04.-06.10.2023. DOI: https://dx.doi.org/10.3205/23dkvf513

Hoppe S, Kotz D, Mons U, Prinz A, Kastaun S. Erhalt  von und Wunsch nach hausärztlicher Beratung zu Bewegung bei koronarer Herzkrankheit: Ergebnisse einer Bevölkerungsbefragung (OptiCor Studie) [Abstract]. Vortrag auf dem 57. Kongress für Allgemeinmedizin und Familienmedizin der DEGAM [Receipt of and wish for general practitioners‘ advice on exercise of people with ischemic heart disease: results of a population survey (OptiCor study) [Abstract]. Presentation at the 57th Congress of General Practice and Family Medicine of DEGAM]. Berlin, 28.-30.09.2023. DOI: https://dx.doi.org/10.3205/23degam246

Prinz A, Leve V, Gummersbach E, Wilm S, Hoppe S, Vogl F, Kirchhof U, Neuhaus A, Kastaun S. Hausärztliche Beratung von Menschen mit koronarer Herzkrankheit zu Bewegung  eine qualitative Studie zu Erfahrungen, Einstellungen und Bedarfen von Hausärzt:innen (OptiCor Studie) [Abstract]. Vortrag auf dem 57. Kongress für Allgemeinmedizin und Familienmedizin der DEGAM [General practitioners‘ advice of people with ischemic heart disease on exercise – a qualitative study on experiences, attitudes and needs of general practitioners (OptiCor study) [Abstract]. Presentation at the 57th Congress of General Practice and Family Medicine of DEGAM]. Berlin, 28.-30.09.2023. DOI: https://dx.doi.org/10.3205/23degam013

Kastaun S, Kotz D, Mons U, Icks A, Vomhoff M, Donner-Banzhoff N, Crutzen R, Kuss O, Wilm S. Ein Beitrag zur Versorgungsforschung in  Deutschland: Fahrplan der OptiCor-Nachwuchsgruppe zur Optimierung der  Behandlung der koronaren Herzkrankheit durch hausärztliches Training in  der Kurzberatung zur körperlichen Aktivität [Abstract]. Vortrag auf dem 21. Deutschen Kongress für Versorgungsforschung (DKVF) [A contribution to health services research in Germany: roadmap of the OptiCor junior research group to optimize the treatment of coronary heart disease by GP training in brief advice on physical activity. Presentation at the 21st German Congress for Health Services Research (DKVF)]. Potsdam, 05.-07.10.2022. DOI: 10.3205/22dkvf225

Kastaun S, Kotz D, Mons U, Icks A, Vomhoff M, Donner-Banzhoff N, Crutzen R, Kuss O, Wilm S. Optimierung des Managements der koronaren Herzkrankheiten durch hausärztliche Kurzberatung zur körperlichen Aktivität: Fahrplan für die BMBF-Nachwuchsgruppe „OptiCor“ [Abstract #119]. Vortrag auf dem 56. Kongress für Allgemeinmedizin und Familienmedizin der DEGAM [Optimizing the management of coronary heart disease through family physicians‘ brief advice on physical activity: roadmap for the BMBF junior research group „OptiCor“ [Abstract #119]. Presentation at the 56th Congress of General Practice and Family Medicine of DEGAM]. Greifswald, 15.-17.09.2022. DOI: 10.3205/22degam121

Sponsored By The Federal Ministry Of Education And Research
(Grant number: 01GY2103)