A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients

Abstract

Background Congestive heart failure (CHF) is a significant health problem in Australia, and disproportionately affects rural Australians. Management of CHF in Australia is heavily centred around the general practitioner (GP). Australian and international literature indicates there is a gap between current and best practice in CHF management. There is little known about the non-pharmacological aspects of management, or CHF management in a rural Australian context. This study aimed to identify what Australian GPs practicing in the Northern Rivers Region of New South Wales, Australia, perceived were the barriers and enablers in the non-pharmacological management of CHF amongst community dwelling patients, to inform healthcare access, resourcing and delivery in Australian rural environments. Methods Qualitative study involving a realist thematic analysis of data collected from semi-structured face-to-face interviews. Results Fifteen GPs and GP trainees participated. Four interlinked key themes underpinning GPs’ experiences with non-pharmacological management of CHF were interpreted from the interview data: (1) resources, (2) complexity of heart failure, (3) relationships, and (4) patient demographics, priorities and views affect how patients engage with non-pharmacological management of CHF. Conclusion Rural Australian GPs face considerable barriers to non-pharmacological management of CHF. The data suggests that increased rural Australian health services and community transportation, multidisciplinary management, and stronger professional networks have the potential to be invaluable enablers of CHF management. Further research exploring non-pharmacological management of CHF in other rural contexts may provide additional insights to better inform rural healthcare access and resourcing.

From guideline to practise

“…Triangulation refers to the use of multiple methods or data resources to enhance the methodology. 29,30 To meet the aims of this study and to develop a comprehensive understanding of the observations, data triangulation, triangulation of data collection and triangulation of analysis methods were applied (Table 6).…”

“…GPs would like to take on patient-education and self-care support but are confronted with limited consultation time. [29][30][31][32] In our study, GPs were also confronted with time-management issues in terms of patienteducation and self-care support (Chapter 5). If they provide patient education, they mainly focus on medical aspects such as diagnosis, medication, smoking and exercise.…”

“…[27][28][29] Engagement in self-care behaviour is essential to achieve long-term stability in HF. 30 It has been shown that patients who have high knowledge of the mechanisms of HF and their relation to its signs and symptoms are more likely to perform necessary self-care behaviour leading to an improved prognosis. 31,32 Moreover, effective self-care is associated with a number of positive outcomes such as QoL, prevention of (re)hospitalisation and maintaining physiologic stability in HF.…”

“…31,32 Moreover, effective self-care is associated with a number of positive outcomes such as QoL, prevention of (re)hospitalisation and maintaining physiologic stability in HF. 29,30,32 However, self-care is complex for patient and their families. Optimal self-care requires understanding of the condition and skills to perform important self-care activities (Table 4).…”

“…In order to support patients and their families to adapt to their chronic condition and to perform self-care, behaviour education about the nature and complexities of HF is essential . 25,27,30,33 Therefore, ESC-guidelines recommend that HC-providers provide comprehensive patient education, and defined 12 key topics and self-care skills that should be addressed (Table 5). 6,34 Table 5.…”