title: Implementing cardiometabolic health checks in general practice: a qualitative process evaluation.
abstract: BACKGROUND
  A stepwise screening approach for the detection and management of cardiometabolic disease is proposed in various primary care guidelines. The aim of this study was to explore the implementation of a cardiometabolic health check as perceived by the involved caregivers and patients.
  
  
  METHODS
  Qualitative process evaluation of the implementation of a cardiometabolic screening programme in a multidisciplinary primary healthcare centre in Eindhoven, the Netherlands, in which 1270 patients had participated. We explored the caregivers' experiences though focus group discussions and collected patients' experiences through a written questionnaire containing two open-ended questions. We analyzed our data using a thematic content analysis based on grounded theory principles.
  
  
  RESULTS
  Five general practitioners, three practice nurses and five medical receptionists participated in the focus groups. Additionally we collected experiences of 657 (52% of 1270) participating patients through an open-ended questionnaire.GPs were enthusiastic about offering a health check and preferred systematic screening over case-finding, both in terms of yield and workload. The level of patient participation was high and most participants were enthusiastic about the health check being offered by their GP. Despite their enthusiasm, the GPs realized that they lacked experience in the design and implementation of a structured, large-scale prevention programme. This resulted in suboptimal instruction of the involved practice nurses and medical receptionists. The recruitment strategy was unnecessarily aggressive. There were shortcomings in communicating the outcomes of the health check to the patients and there was no predefined follow-up programme. Based on our findings we developed a checklist that can be used by designers of similar health checks.
  
  
  CONCLUSIONS
  A number of fundamental issues may arise when GPs organize a systematic screening programme in their practice. These issues are related to the preparation of the involved staff, the importance of integration with everyday clinical practice, the approach of healthy patients and the provision of adequate follow-up programmes. The identified challenges and recommendations can be taken into account during future screening programmes.
authors.affiliation: CAPHRI: School for Public Health and Primary Care, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, Maastricht 6200MD, The Netherlands. merijn.godefrooij@maastrichtuniversity.nl.
authors.forename: Merijn
authors.initials: M
authors.lastname: Godefrooij
authors.forename: Mark
authors.initials: M
authors.lastname: Spigt
authors.forename: Wim
authors.initials: W
authors.lastname: van der Minne
authors.forename: Georgette
authors.initials: G
authors.lastname: Jurrissen
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
authors.forename: André
authors.initials: A
authors.lastname: Knottnerus
mesh_terms: D000328:Adult; D057179:Advanced Practice Nursing; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003920:Diabetes Mellitus / Q000175:diagnosis*; D017144:Focus Groups; D058006:General Practice; D006801:Humans; D008403:Mass Screening; D008496:Medical Receptionists; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000379:methods*; D017064:Process Assessment, Health Care; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires