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Table 3 Summary of proposals to enhance integration of healthy lifestyle promotion into PHC

From: Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers

1.- Increase availability of resources
   • Increase the interaction time between patients and professionals in order to open their work agendas to health promotion:
- review care protocols for healthy people
- decrease checks for people with chronic diseases, promoting patient self-control and autonomy
- expressly prioritise health promotion activities and the reminding and recording of such activities
- effective administrative support to free practitioners from administrative and bureaucratic tasks
- communication, task redistribution, coordination and mutual support between physicians and nurses.
   • Health policies defining the role of PHC in health promotion.
   • Agreements between funding bodies and service providers specifically stating health promotion objectives, resources and indicators for evaluation.
   • Participation of professionals in planning and quality evaluation of PHC services:
- promote communication within the health-care system
- establish common health promotion objectives for all professionals in the health-care organisation
- negotiate evaluation indicators shared by all groups.
   • Actions at an inter-institutional level: town councils, schools, health-care centres, citizens' organisations, etc.
- designate a health promotion coordinator post at district or town level
- integrate initiatives and resources of the different sectors involved.
2.- Design of intervention programs
   • Review their rationale based on scientific evidence of their effectiveness.
   • Promote research into health promotion in PHC.
   • Prioritise programs that are more flexible and adaptable to context.
   • Participation of clinicians and researchers in the design and evaluation of new interventions.
   • Use new support and reminder tools that do not interfere with the clinical practice of professionals.
   • Take advantage of the new technologies for citizen information and education.
3.- Program dissemination
   • Fight against resistance to change using outcome research.
   • Set up a network of centres particularly interested in innovation for addressing multiple risk factors in PHC.
   • Experience-based training and action-oriented skills.