GPs' perspectives on secondary cardiovascular prevention in older age: a focus group study in the Netherlands.
BACKGROUND
Although guidelines recommend secondary cardiovascular prevention irrespective of age, in older age the uptake of treatment is lower than in younger age groups.


OBJECTIVE
To explore the dilemmas GPs in the Netherlands encounter when implementing guidelines for secondary cardiovascular prevention in older age.


METHODS
Qualitative study in four focus groups consisting of GPs (n = 23, from the northern part of the province South Holland) and a fifth focus group consisting of GP trainees (n = 4, from the Leiden University Medical Center).


METHODS
Focus group discussions were organised to elicit perspectives on the implementation of secondary cardiovascular prevention for older people. The 14 theoretical domains of the refined Theoretical Domains Framework (TDF) were used for (deductive) coding of the focus group discussions. The coded texts were analysed, content was discussed, and barriers and facilitators were identified for each domain of the TDF.


RESULTS
The main theme that emerged was 'uncertainty'. Identified barriers were guideline-related, patient-related, and organisation-related. Identified facilitators were doctor-related, patient-related, and organisation-related. The main aim of secondary preventive treatment was improvement in quality of life.


CONCLUSIONS
GPs in the Netherlands are uncertain about many aspects of secondary cardiovascular prevention in older age; the guidelines themselves, their own role, patient factors, and the organisation of care. In view of this uncertainty, GPs consciously weigh all aspects of the situation in close dialogue with the individual patient, with the ultimate aim of improving quality of life. This highly-individualised care may largely explain the reduced prescription rates.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Petra G
PG
van Peet
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Yvonne M
YM
Drewes
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Jacobijn
J
Gussekloo
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Wouter
W
de Ruijter
D000368:Aged; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011788:Quality of Life; D055502:Secondary Prevention / Q000379:methods
cardiovascular; general practice; guidelines as topic; older age; secondary prevention