title: Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.
abstract: BACKGROUND
  Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands.
  
  
  METHODS
  We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors.
  
  
  RESULTS
  Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management.
  
  
  CONCLUSIONS
  Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Elke.Huntink@radboudumc.nl.
authors.forename: E
authors.initials: E
authors.lastname: Huntink
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Michel.Wensing@radboudumc.nl.
authors.forename: M
authors.initials: M
authors.lastname: Wensing
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), PO Box 9101, 6500 HB, Nijmegen, The Netherlands. maklomp@nlzorg.net.
authors.forename: M A
authors.initials: MA
authors.lastname: Klomp
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Jan.vanLieshout@radboudumc.nl.
authors.forename: J
authors.initials: J
authors.lastname: van Lieshout
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009426:Netherlands / Q000453:epidemiology; D010465:Perception; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D012307:Risk Factors; D012308:Risk Management / Q000458:organization & administration*