Cardiovascular Risk Management in Australian General Practice

Heeley, Emma; Bayram, Clare; Patel, Anushka

doi:10.1016/j.hlc.2007.06.490

Cited by 7 publications

(9 citation statements)

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“…Capability barriers included uncertainty about additional factors not included in the AR model, and poor The opportunity and capability barriers described above are in line with previous research on the barriers to AR assessment, but they have not previously been linked to alternative assessment strategies used in clinical practice. 10,12,18 Motivational barriers have not been a major focus in previous research on ways to improve the use of AR guidelines in practice. However, our findings suggest that motivation helps explain the inconsistent use of AR guidelines by GPs.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Basing treatment decisions on high AR rather than high individual risk factors may prevent overtreatment of patients with isolated risk factors but low to moderate overall risk, and undertreatment of patients with high overall risk. 8,9 However, international [10][11][12][13] and Australian [14][15][16][17][18] research suggests that CVD risk management is not consistently based on AR. Possible barriers to general practitioners using AR assessment include lack of time, accessibility, knowledge and trust; conflicting guidelines; difficulty understanding and explaining AR; and focusing on individual risk factors that may not be included in AR models.…”

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confidence: 99%

“…Possible barriers to general practitioners using AR assessment include lack of time, accessibility, knowledge and trust; conflicting guidelines; difficulty understanding and explaining AR; and focusing on individual risk factors that may not be included in AR models. [10][11][12][13][14][15][16][17][18] According to the "behaviour change wheel" framework, these factors may act as barriers to the use of AR assessment through three determinants of behaviour: opportunity (eg, access), capability (eg, knowledge) and motivation (eg, trust). 19 Little is known about how and why GPs do use AR in CVD risk assessment, and the alternative strategies employed when AR is not the focus of assessment.…”

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confidence: 99%

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General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

Bonner

Jansen

McKinn

et al. 2013

Medical Journal of Australia

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Research urrent guidelines for cardiovascular disease (CVD) prevention advocate the use of absolute risk (AR) assessment to guide the use of preventive medication, rather than treating blood pressure and cholesterol separately. 2-5 Age, sex, smoking, diabetes, systolic blood pressure and cholesterol ratio are used to estimate the risk of a cardiovascular event in the next 5 years. Preventive medication is recommended if AR is higher than 15%, or 10%-15% with other risk factors. 2,3 Reviews suggest that the AR approach may improve the clinical management of CVD without harm to patients. 6,7 Basing treatment decisions on high AR rather than high individual risk factors may prevent overtreatment of patients with isolated risk factors but low to moderate overall risk, and undertreatment of patients with high overall risk. 8,9 However, international 10-13 and Australian 14-18 research suggests that CVD risk management is not consistently based on AR. Possible barriers to general practitioners using AR assessment include lack of time, accessibility, knowledge and trust; conflicting guidelines; difficulty understanding and explaining AR; and focusing on individual risk factors that may not be included in AR models.10-18 According to the "behaviour change wheel" framework, these factors may act as barriers to the use of AR assessment through three determinants of behaviour: opportunity (eg, access), capability (eg, knowledge) and motivation (eg, trust). 19Little is known about how and why GPs do use AR in CVD risk assessment, and the alternative strategies employed when AR is not the focus of assessment. We aimed to investigate GPs' views and experiences of CVD risk assessment to identify factors that influence the extent to which Australian AR assessment guidelines are used. MethodsWe used purposive sampling to recruit participants, aiming for maximum variation among a set of characteristics known to influence CVD risk management (Box 1). [20][21][22] Invitation letters were posted to all 3743 members of eight Divisions of General Practice in metropolitan New South Wales. Of 55 GPs who returned expression of interest forms, we allocated 25 to this study. GPs signed a consent form before participating in person (two participants) or via telephone (23 participants). They received $100 for their time. Preliminary analysis suggested saturation of key themes related to the range of CVD risk assessment strategies described by GPs, so no further recruitment was conducted.23 Ethics approval was obtained through the Sydney Local Health District Human Research Ethics Committee.A semi-structured interview schedule covering CVD risk assessment and management was developed (Appendix 1; online at mja.com.au), piloted with two GPs, and clarified. Interviews lasted between 22 and 55 minutes, and de-identified audiorecordings were transcribed verbatim. Between October 2011 and May 2012, interviews were conducted by two of us (C B, S M) who have qualifications in public health.We used a framework analysis method 24 and summarised data w...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

Bonner

Jansen

McKinn

et al. 2013

Medical Journal of Australia

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“…13,14 Uptake of risk calculators into routine clinical practice has been slow, 15 and they remain under-used in primary care. 11,[16][17][18][19][20] Further general practice-based evidence is needed to convince patients and doctors that greater benefits can be achieved by shifting to calculations of absolute risk, rather than achieving traditional target guidelines for individual relative risk factors. The New Zealand (NZ) Cardiovascular Risk Calculator…”

Section: Introductionmentioning

confidence: 99%

The Fremantle Primary Prevention Study: a multicentre randomised trial of absolute cardiovascular risk reduction

Brett¹,

Arnold-Reed²,

Phan³

et al. 2012

Br J Gen Pract

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BackgroundCardiovascular disease (CVD) is the leading cause of global mortality. Risk factor management in clinical practice often relies on relative risk modification rather than the more appropriate absolute risk assessment. AimTo determine whether patients receiving morefrequently designated GP visits had increased benefit in terms of their absolute CVD risk assessment, as compared with patients in receipt of their usual GP care. Design and settingProspective, open, pragmatic block randomised study in a 1:1 group allocation ratio in three Western Australian general practices. MethodA convenience sample (n = 1200) of patients aged 40-80 years were randomised to 3-monthly GP visits (five in total for the intensive) or usual GP care (two in total for the opportunistic), with 12 months' follow-up. The main outcome was absolute CVD risk scores based on the New Zealand Cardiovascular Risk Calculator. Others outcome measures were weight, height, waist circumference, blood pressure, and fasting blood lipids and glucose. ResultsThere were 600 patients per group at baseline. At 12 months' analysis there were 543 in the intensive group and 569 in the opportunistic group. Mean (standard deviation [SD] ConclusionA targeted approach using absolute risk calculators can be used in primary care to modify global CVD risk assessment.

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“…3,4 Nonadherence to the treatment is likely to further extend this treatment gap because it is estimated that ≤50% of patients in highincome countries do not adhere to prescribed cardiovascular disease (CVD) medications, with similar suboptimal adherence in low-and middle-income countries. 5,6 The reasons for nonadherence fit into well-recognized categories-health system, condition, patient, therapy, and socioeconomic.…”

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confidence: 99%

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Liu¹,

Massi²,

Laba³

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background-This study explores health provider and patient attitudes toward the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention. Methods and Results-In-depth, semistructured interviews (n=94) were conducted with health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and indigenous patients thought the strategy acceptable and beneficial for indigenous patients given the high disease burden. Providers noted the inflexibility of the fixed dose regimen, with dosages sometimes inappropriate for patients with complex management considerations. Future polypill formulations with varied strengths and classes of medications may overcome this barrier. Many providers suggested the polypill strategy, in its current formulations, might be more suited to high-risk primary prevention patients. Conclusions-The polypill strategy was generally acceptable to patients and providers in cardiovascular prevention.Limitations to provider acceptability of this particular polypill were revealed, as was a perception it might be more suitable for high-risk primary prevention patients, though future combinations could facilitate its use in secondary prevention. Participants suggested a polypill-based strategy as particularly appropriate for lowering the high cardiovascular burden in indigenous populations. Clinical Trial Registration-URL: http://www.anzctr.org.au. ANZCTRN: 12608000583347.(Circ Cardiovasc Qual Outcomes. 2015;8:301-308.

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Cardiovascular Risk Management in Australian General Practice

Cited by 7 publications

References 0 publications

General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

The Fremantle Primary Prevention Study: a multicentre randomised trial of absolute cardiovascular risk reduction

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

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