Barriers to implementing cardiovascular risk tables in routine general practice
Open accessAbstract
DESIGN: Qualitative study. GPs were interviewed after analysing two audiotaped cardiovascular consultations. SETTING: Primary health care. SUBJECTS: A sample of 15 GPs who audiotaped 22 consultations. MAIN OUTCOME MEASURES: Barriers hampering GPs from following the guideline. RESULTS: Data saturation was reached after about 13 interviews. The 25 identified barriers were related to the risk table, the GP or to environmental factors. Lack of knowledge and poor communication skills of the GP, along with pressure of work and demanding patients, cause GPs to deviate from the guideline. GPs regard barriers external to themselves as most important. CONCLUSION: Using the risk table as a key element of the high-risk approach in primary prevention encounters many barriers. Merely incorporating risk tables in guidelines is not sufficient for implementation of the guidelines. Time-efficient implementation strategies dealing in particular with the communication and presentation of cardiovascular risk are needed.
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A Dutch qualitative study reported that physicians' knowledge of risk tables and their ability to communicate that knowledge influenced implementation.
“A Dutch qualitative study of the use of risk tables as a key component of risk assessments for primary prevention reported that physicians' knowledge of the risk tables and ability to communicate that knowledge to the patient influenced their implementation.545”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [545]
Physicians are concerned about overestimating risk in national populations, which may lead to overuse of medical therapy.
“Physicians are also concerned about overestimating risk in national populations, which may lead to overuse of medical therapy.545,547”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [545]
The length of routine patient consultations is widely recognized as a barrier to conducting risk assessments.
“The length of routine patient consultations, which provides little time for discussion, is widely recognized as a barrier to conducting risk assessments.545,547”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [545]
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- Authors
- Steenkiste, B. V., Weijden, T. V. D., Stoffers, H. E. J. H., & Grol, R.
- Affiliations
- Maastricht University (NL)
- Corresponding author
- Steenkiste, Ben van
- Venue
- Scandinavian Journal of Primary Health Care
- Publisher
- Informa UK Limited
- Published
- 2004-03
- Volume
- 22
- Issue
- 1
- Pages
- 32-37
- ISSN
- 0281-3432 (ISSN-L)
- 1502-7724
- OpenAlex
- W1995918858
- Cited by
- 104
- References
- 21
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 9 · 2018: 1 · 2017: 4 · 2016: 6 · 2015: 5 · 2014: 6 · 2013: 8 · 2012: 11
- FWCI
- 8.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Scandinavian Journal of Primary Health Care (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- guideline implementation, implementation barriers, general practitioners, cardiovascular risk communication, primary prevention, high-risk approach, occupational stress, patient demand, primary care
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Clinical Competence, Family Practice, Female, Humans, Interviews as Topic, Male, Middle Aged, Netherlands, Primary Health Care, Quality Assurance, Health Care, Risk Factors, Practice Guidelines as Topic, Risk Assessment, Guideline Adherence, Qualitative Research
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