title: Why are there gaps in our management of those with high cardiovascular risk?
abstract: BACKGROUND
  Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk.
  
  
  METHODS
  This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data.
  
  
  RESULTS
  The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership.
  
  
  CONCLUSIONS
  This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector.
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand. Fiona@xtra.co.nz
authors.forename: Fiona
authors.initials: F
authors.lastname: Doolan-Noble
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Tracey
authors.forename: Stewart
authors.initials: S
authors.lastname: Mann
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019468:Disease Management; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D009520:New Zealand; D009722:Nurse Practitioners / Q000523:psychology*; D058007:Physicians, Primary Care / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D018570:Risk Assessment