title: Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis.
abstract: General practitioners (GPs) play a key role in heart failure (HF) management. Despite multiple guidelines, the management of patients with HF in primary care is suboptimal. Therefore, all the qualitative evidence concerning GPs' perceptions of managing HF in primary care was synthesised to identify barriers and facilitators for optimal care, and ideas for improvement.
  
  
  
  Qualitative evidence synthesis.
  
  
  
  Searches of MEDLINE, EMBASE, Web of Science and CINAHL databases up to 20/12/2015 were conducted. The Critical Appraisal Skills Programme's checklist for qualitative research was used for quality assessment. Thematic analysis was used as method of analysis.
  
  
  
  Of 5427 articles, 18 qualitative articles were included. Findings were organised in HF-specific factors, patient factors, physician factors and contextual factors. GPs' uncertainty in all areas of HF management was highlighted. HF management started with an uncertain diagnosis, leading to difficulties with communication, treatment and advance care planning. Lack of access to specialised care and lack of knowledge were identified as important contributors to this uncertainty. In an effort to overcome this, strategies bringing evidence into practice should be promoted. GPs expressed the need for a multidisciplinary chronic care approach for HF. However, mixed experiences were noted with regard to interprofessional collaboration.
  
  
  
  The main challenges identified in this synthesis were how to deal with GPs' uncertainty about clinical practice, how to bring evidence into practice and how to work together as a multiprofessional team. These barriers were situated predominantly on the physician and contextual level. Targets to improve GPs' HF care were identified.
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
authors.forename: Miek
authors.initials: M
authors.lastname: Smeets
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
authors.forename: Sara
authors.initials: S
authors.lastname: Van Roy
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Vermandere
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.|Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Vaes
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D058005:General Practitioners / Q000523:psychology; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D010819:Physician's Role; D011320:Primary Health Care / Q000592:standards; D036301:Qualitative Research; D058996:Quality Improvement / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data*
keywords: PRIMARY CARE; QUALITATIVE RESEARCH