title: Delivering a national programme of anticipatory care in primary care: a qualitative study.
abstract: BACKGROUND
  Primary prevention often occurs against a background of inequalities in health and health care. Addressing this requires practitioners and systems to acknowledge the contribution of health-related and social determinants and to deal with the lack of interconnectedness  between health and social service providers. Recognising this, the Scottish Government has implemented a national programme of anticipatory care targeting individuals aged 45-64 years living in areas of socioeconomic deprivation and at high risk of cardiovascular disease. This programme  is called Keep Well.
  
  
  OBJECTIVE
  To explore the issues and tensions underpinning the implementation of a national programme of anticipatory care.
  
  
  METHODS
  A qualitative study in five Wave 1 Keep Well pilot sites, located in urban areas of Scotland,  and involving 79 general practices.
  
  
  METHODS
  Annual semi-structured interviews were conducted with 74 key stakeholders operating at national government level, local pilot level and within general practices, resulting in 118 interviews. Interview transcripts were analysed  using the framework approach.
  
  
  RESULTS
  Four underlying tensions were identified. First, those between a patient-focused general-practice approach versus a population-level health-improvement approach, linking disparate health and social services; secondly, medical approaches  versus wider social approaches; thirdly, a population-wide approach versus individual targeting; and finally, reactive versus anticipatory care.
  
  
  CONCLUSIONS
  Implementing an anticipatory care programme to address inequalities in cardiovascular disease identified several tensions,  which need to be understood and resolved in order to inform the development of such approaches in general practice and to develop systems that reduce the degree of fragmentation across health and social services.
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow. Kate.O’Donnell@glasgow.ac.uk
authors.forename: Catherine A
authors.initials: CA
authors.lastname: O'Donnell
authors.forename: Mhairi
authors.initials: M
authors.lastname: Mackenzie
authors.forename: Maggie
authors.initials: M
authors.lastname: Reid
authors.forename: Fiona
authors.initials: F
authors.lastname: Turner
authors.forename: Julia
authors.initials: J
authors.lastname: Clark
authors.forename: Yinging
authors.initials: Y
authors.lastname: Wang
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sridharan
authors.forename: Stephen
authors.initials: S
authors.lastname: Platt
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000458:organization & administration*; D058006:General Practice / Q000458:organization & administration*; D006291:Health Policy; D006293:Health Promotion; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D011322:Primary Prevention / Q000458:organization & administration*; D012606:Scotland; D014504:Urban Health