title: Priorities for action to improve cardiovascular preventive care of patients with multimorbid conditions in primary care--a participatory action research project.
abstract: BACKGROUND
  Cardiovascular disease (CVD) prevention in patients with multimorbid conditions is not always optimal in primary care (PC). Interactive collaborative processes involving PC community are recommended to develop new models of care and to successfully reshape clinical practices.
  
  
  OBJECTIVE
  To identify challenges and priorities for action in PC to improve CVD prevention among patients with multimorbid conditions.
  
  
  METHODS
  Physicians (n = 6), nurses (n = 6), community pharmacists (n = 6), other health professionals (n = 6), patients (n = 6) and family members (n = 6), decision makers (n = 6) and researchers (n = 6) took part in a 1-day workshop. Using the Chronic Care Model (CCM) as a framework, participants in focus groups and nominal groups identified the challenges and priorities for action.
  
  
  RESULTS
  Providing appropriate support to lifestyle change in patients and implementing collaborative practices are challenging. Priorities for action relate to three CCM domains: (i) improve the clinical information system by providing computerized tools for interprofessional and interinstitutional communication, (ii) improve the organization of health care and delivery system design by enhancing interprofessional collaboration, especially with nurses and pharmacists, and creating care teams that include a case manager and (iii) improve self-management support by giving patients access to nutritionists, to personalized health care plans including lifestyle recommendations and to other resources (community resources, websites).
  
  
  CONCLUSIONS
  To optimize CVD prevention, PC actors recommend focussing mainly on three CCM domains. Electronic medical records, collaborative practices and self-management support are perceived as pivotal aspects of successful PC prevention programme. Developing and implementing such models are challenging and will require the mobilization of the whole PC community.
authors.affiliation: Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, Quebec, Canada. lyne.lalonde@umontreal.ca
authors.forename: Lyne
authors.initials: L
authors.lastname: Lalonde
authors.forename: Johanne
authors.initials: J
authors.lastname: Goudreau
authors.forename: Éveline
authors.initials: É
authors.lastname: Hudon
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Lussier
authors.forename: Fabie
authors.initials: F
authors.lastname: Duhamel
authors.forename: Danielle
authors.initials: D
authors.lastname: Bélanger
authors.forename: Lise
authors.initials: L
authors.lastname: Lévesque
authors.forename: Élisabeth
authors.initials: É
authors.lastname: Martin
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015897:Comorbidity; D017144:Focus Groups; D006282:Health Personnel / Q000193:education; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care; D011322:Primary Prevention; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D011792:Quebec