Evidence-based cardiovascular care. Family physicians' views of obstacles and opportunities.
OBJECTIVE
To explore obstacles to and opportunities for applying specific lifestyle and pharmacologic recommendations on chronic ischemic heart disease.


METHODS
Qualitative study.


METHODS
Rural, town, and city settings in Nova Scotia.


METHODS
Fifty family physicians caring for patients with cardiovascular (CV) disease.


METHODS
Nine focus groups were conducted, audiotaped, and transcribed. Seven recommendations had been selected for discussion based on their relevance to primary care, strength, and class of supporting evidence. Analysis was guided by grounded-theory methodology.


RESULTS
"Ischemic events" can be powerful motivators for change, whereas the asymptomatic nature of CV risks and distant outcomes can form obstacles. Trust built through previous experiences and the opportunity to repeat important messages can facilitate application of evidence, but patient-physician relationships can also pose obstacles.


CONCLUSIONS
Physicians can take steps to improve care, but success at reducing CV risks depends upon active involvement of many health professionals and community resources. Future guideline implementation should focus on patient-oriented issues, such as comorbidity and treatment preferences.
Putnam
Wayne
W
Dalhousie University, Department of Family Medicine, Halifax, NS. Wayne.Putnam@Dal.Ca
Twohig
Peter L
PL
Burge
Frederick I
FI
Jackson
Lois A
LA
Cox
Jafna L
JL
D001291:Attitude of Health Personnel; D002170:Canada; D019317:Evidence-Based Medicine; D017144:Focus Groups; D006801:Humans; D008019:Life Style; D017202:Myocardial Ischemia / Q000628:therapy*; D010817:Physician-Patient Relations; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care