Barriers to detecting and treating hypercholesterolaemia in patients with ischaemic heart disease: primary care perceptions.
BACKGROUND
Treating hypercholesterolaemia in patients with ischaemic heart disease can significantly reduce vascular deaths and events. Many such patients, however, do not receive effective treatment for hypercholesterolaemia.


OBJECTIVE
To ascertain the barriers to the detection and treatment of hypercholesterolaemia in patients with ischaemic heart disease as seen by primary care teams.


METHODS
Qualitative study using the nominal group technique.


METHODS
General practice teams in the North Thames region of the Medical Research Council General Practice Research Framework.


METHODS
The main outcomes measures used were identification of the barriers to the detection and treatment of hypercholesterolaemia together with relative rankings.


RESULTS
Fourteen individual barriers were identified. The main barriers were: organisational barriers within general practices; confusing and conflicting guidelines from external sources; errors and omissions by GPs; communication problems at the interface between secondary and primary care; and reluctance by patients to take medication.


CONCLUSIONS
The reasons for suboptimal detection and treatment of hypercholesterolaemia are complex and act at various levels. Interventions to improve the management of this condition must address these barriers in order to be successful.
Hickling
James
J
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London. james.hickling@gp-F83063.nhs.uk
Rogers
Stephen
S
Nazareth
Irwin
I
D001291:Attitude of Health Personnel; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005194:Family Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008485:Medical Audit; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications*; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians'
D004791:Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors