title: Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study.
abstract: OBJECTIVE
  This paper reports on a study of the experiences of general practitioners and practice nurses implementing nurse-delivered cardiovascular prevention to high risk patients in primary care.
  
  
  BACKGROUND
  Difficulties may arise when innovations are introduced into routine daily practice. Whether or not implementation is successful is determined by different factors related to caregivers, patients, type of innovation and context.
  
  
  METHODS
  A qualitative study nested in a randomized trial (2006-2008) to evaluate the effectiveness of nurse-delivered cardiovascular prevention. Six primary health care centres in the Netherlands (25 general practitioners, 6 practice nurses) participated in the trial. Interviews were held on two occasions: at 3 and at 18 months after commencement of consultation. The first occasion was a group interview with six practice nurses. The second consisted of semi-structured interviews with one general practitioner and one practice nurse from each centre.
  
  
  RESULTS
  Main barriers to the implementation included: lack of knowledge about the guideline, attitudes towards treatment targets, lack of communication, insufficient coaching by doctors, content of life style advice. At the start of the consultation project, practice nurses expressed concern of losing nursing tasks. Other barriers were related to patients (lack of motivation), the guideline (target population) and organizational issues (insufficient patient recording and computer systems).
  
  
  CONCLUSIONS
  Both general practitioners and practice nurses were positive about nurse-delivered cardiovascular prevention in primary care. Nurses could play an important role in successive removal of barriers to implementation of cardiovascular prevention. Mutual confidence between care providers in the healthcare team is necessary.
authors.affiliation: Researcher Department of Integrated Health Care, Maastricht University Medical Centre/CAPHRI, The Netherlands.
authors.forename: Helene R
authors.initials: HR
authors.lastname: Voogdt-Pruis
authors.forename: George H M I
authors.initials: GH
authors.lastname: Beusmans
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
authors.forename: Jan W
authors.initials: JW
authors.lastname: van Ree
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000451:nursing* / Q000517:prevention & control*; D003142:Communication; D058005:General Practitioners; D017408:Guidelines as Topic; D006801:Humans; D007400:Interprofessional Relations; D009426:Netherlands; D009722:Nurse Practitioners; D024802:Nurse's Role; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research