Implementation fidelity of lifestyle counselling in accordance with the selective contract for care in the specialist area of orthopedics pursuant to 73c SGB V A descriptive analysis of the view of practising physicians and medical assistants in Baden-Wurttemberg

Background and objectives The selective contract for care in the specialist area of orthopedics in Baden-Wurttemberg (FAV Orthopedics) in accordance with 73c SGB V aims to reduce the overuse, underuse and misuse of care for musculoskeletal diseases and to improve the quality of such care by means of guideline-based patient care. A core element of the FAV Orthopedics is the counselling fee for a motivational and preventive counselling for lifestyle modification and strengthening of self-management according to a 4-step concept. The aim of our study was to assess the feasibility of implementing the FAV Orthopedics from the point of view of the participating physicians and medical assistants, to document the implementation fidelity of lifestyle counselling according to the 4-step concept as well as the self-reported success of counselling and barriers to lifestyle counselling. Method We conducted an anonymous online survey with both target groups. The implementability was assessed using the Hexagon tool. The participants also indicated which counselling contents they carry out according to the 4-step concept (implementation fidelity) and which obstacles they experience (barriers). The self-reported success of counselling was documented for the areas of exercise, nutrition, smoking and stress management. The data were analyzed descriptively. Results One third of physicians (n = 191) and 101 medical assistants answered the questions on implementation. The majority assessed the feasibility of implementing the FAV Orthopedics positively. We documented a (very) high implementation fidelity (lifestyle counselling according to the 4-step concept) (n = 53 physicians; n = 81 medical assistants). While slightly more than one third of the physicians saw no barriers, over 60% still indicated barriers to routine counselling. The self-assessed success of counselling for both professional groups surveyed was relatively high in the area of exercise, moderate in the areas of nutrition and stress management and rather low in the area of smoking cessation. Discussion The present data suggest that the FAV Orthopedics can be integrated into everyday practice. The FAV creates framework conditions that enable a high prevalence of lifestyle counselling, even if spatial and temporal barriers as well as patient-related obstacles are still reported in some cases. In summary, our study provides evidence that the FAV Orthopedics strengthens biopsycho-ocial and guideline-based care in the field of musculoskeletal diseases.