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An exploratory study of facilitators and barriers to the primary care management of those with high cardiovascular risk

Primary health care Disease management Cardiovascular diseases Pacific Area

Background: In 2003 the New Zealand Guidelines on the screening and management of patients for cardiovascular risk were published, with a revised handbook for primary healthcare staff updated in 2009. Several studies however have identified a significant gap between the guideline recommendations and current practice. This study was initiated to investigate the possible reasons for the evidence-practice gap.Aim and objectivesThe aim of this research study was to explore how primary health care teams manage those at high risk of cardiovascular disease (CVD) and what changes could be made that would enhance management.The study objectives were:To explore how those found to be at high risk of a cardiovascular event are managed in primary care;To determine what facilitates and hinders CVD risk management at practice level in the current primary health care environment in New Zealand;To establish what strategies and support providers would like to enhance the current management of those at high risk.MethodsA qualitative approach was utilised for this study using focus groups for the collection of relevant information and opinions. Following the review of the literature an interview schedule was developed to guide the focus group discourse. The selection of the focus groups was guided by a sampling frame which ensured that they were drawn from a variety of settings. Focus groups were digitally recorded and the recordings transcribed. The Chronic Care Model (CCM) was used as a framework to guide consideration of the literature review findings as well as the process of analysing the text data. The text data was analysed using a general inductive approach which resulted in the emergence of key themes. FindingsThere was a high level of conformity between the findings from the focus group and the literature review but some additional issues did emerge. The self management domain and the delivery system domain of the CCM dominated both the findings from the literature and the themes from the focus groups. The decision support domain appears to have a moderate impact on optimal management of cardiovascular risk, both in the literature and from the focus group findings. Participants in the focus groups identified more barriers to optimal management of those at high cardiovascular risk related to the health system organisation domain, than emerged from the literature. Surprisingly they identified no barriers or facilitators to the use of community resources to assist them in supporting individuals with lifestyle behaviour changes.ConclusionThis study, elicited new perspectives from New Zealand primary healthcare staff, relevant to issues surrounding the management of patients at high cardiovascular risk. The research has elucidated drivers of sub-optimal management and highlighted solutions available to address the issues within the current New Zealand primary health care environment.

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