Coronary heart disease multiple risk factor reduction. Providers' perspectives.
BACKGROUND
Although primary care physicians understand the importance of preventive services for patients with multiple risk factors (MRF) for coronary heart disease, physician intervention is limited. This study investigated (1) physicians' views of challenges faced in managing patients with MRF; (2) the counseling and management methods they utilize; and (3) possible strategies to enhance MRF intervention in the primary care setting.


METHODS
Two focus groups were conducted with primary care physicians from varying settings to gain insight into these issues noted above. Each group was co-facilitated by a physician and a behavioral scientist using a previously developed semistructured interview guide. The group discussions were tape recorded and subsequently transcribed. Transcripts were analyzed using the constant comparative method for analysis.


RESULTS
Physicians are challenged by knowledge limitations (contribution of individual risk factors to overall risk); limited support (guidelines, materials, and staff); and logistic difficulties (organizational issues, time limitations). Their approach to MRF management tends to be highly individualized with an initial preference for lifestyle change interventions rather than prescription of medications with some qualifying circumstances. Physicians favored a serial rather than a parallel approach to MRF intervention, starting with behaviors that the patient perceives as a priority. Proposed solutions to current challenges emphasize physician education and the development of innovative approaches that include physician assistance and a team approach.


CONCLUSIONS
Physicians are aware of and sensitive to the complexity of MRF management for their patients and themselves. However, future MRF interventions will require nonphysician staff involvement and increased systems support.
Rosal
Milagros C
MC
Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. Milagros.Rosal@umassmed.edu
Ockene
Judith K
JK
Luckmann
Roger
R
Zapka
Jane
J
Goins
Karin Valentine
KV
Saperia
Gordon
G
Mason
Theresa
T
Donnelly
Gary
G
D000328:Adult; D003327:Coronary Disease / Q000209:etiology* / Q000517:prevention & control; D048909:Diabetes Complications; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000458:organization & administration; D011320:Primary Health Care; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D000074606:Smoking Prevention