'I saw the panic rise in her eyes, and evidence-based medicine went out of the door.' An exploratory qualitative study of the barriers to secondary prevention in the management of coronary heart disease.
Background. Coronary heart disease (CHD) is the leading cause of death in the UK, yet only 50% of CHD patients receive appropriate secondary prevention. Objectives. To explore GP attitudes to evidence about CHD, and to identify factors influencing the implementation of secondary prevention in GP consultations.


METHODS
Semi-structured interviews and focus groups exploring consultations with patients previously diagnosed as having CHD.


RESULTS
Use of evidence is influenced by credibility. Lack of time was the greatest barrier to accessing evidence and to implementing secondary prevention. Patients were more likely to receive secondary prevention in a dedicated clinic. Patient characteristics including physical and mental co-morbidity mitigate against secondary prevention. GPs experienced difficulty balancing implementation of evidence with the demands of the doctor-patient relationship.


CONCLUSIONS
The doctor-patient relationship may act as a barrier to the delivery of secondary prevention in primary care. It may be time to re-evaluate models of these relationships and reconsider the strategies for implementing evidence.
Summerskill
William S M
WS
GP, Saintbridge Surgery, Askwith Road, Gloucester, UK.
Pope
Catherine
C
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003327:Coronary Disease / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D012307:Risk Factors