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General practitioners’ perspectives on the prevention of cardiovascular disease: systematic review and thematic synthesis of qualitative studies
  1. Irene Ju1,2,
  2. Emily Banks3,4,
  3. Bianca Calabria3,5,
  4. Angela Ju1,2,
  5. Jason Agostino6,
  6. Rosemary J Korda3,
  7. Tim Usherwood7,
  8. Karine Manera1,2,
  9. Camilla S Hanson1,2,
  10. Jonathan C Craig1,2,
  11. Allison Tong1,2
  1. 1 Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  3. 3 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  4. 4 Sax Institute, Haymarket, New South Wales, Australia
  5. 5 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
  6. 6 Academic Unit of General Practice, School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
  7. 7 Department of General Practice, Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Ms Irene Ju; euju2374{at}uni.sydney.edu.au

Abstract

Objective Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally, and prevention of CVD is a public health priority. This paper aims to describe the perspectives of general practitioners (GPs) on the prevention of CVD across different contexts.

Design Systematic review and thematic synthesis of qualitative studies using the Enhancing Transparency of Reporting the Synthesis of Qualitative research (ENTREQ) framework.

Data sources MEDLINE, Embase, PsycINFO and CINAHL from database inception to April 2018.

Eligibility criteria for selecting studies We included qualitative studies on the perspectives of GPs on CVD prevention.

Data extraction and synthesis We used HyperRESEARCH to code the primary papers and identified themes.

Results We selected 34 studies involving 1223 participants across nine countries. We identified six themes: defining own primary role (duty to prescribe medication, refraining from risking patients’ lives, mediating between patients and specialists, delegating responsibility to patients, providing holistic care); trusting external expertise (depending on credible evidence and opinion, entrusting care to other health professionals, integrating into patient context); motivating behavioural change for prevention (highlighting tangible improvements, negotiating patient acceptance, enabling autonomy and empowerment, harnessing the power of fear, disappointment with futility of advice); recognising and accepting patient capacities (ascertaining patient’s drive for lifestyle change, conceding to ingrained habits, prioritising urgent comorbidities, tailoring to patient environment and literacy); avoiding overmedicalisation (averting long-term dependence on medications, preventing a false sense of security, minimising stress of sickness) and minimising economic burdens (avoiding unjustified costs to patients, delivering practice within budget, alleviating healthcare expenses).

Conclusions GPs sought to empower patients to prevent CVD, but consideration of patients’ individual factors was challenging. Community-based strategies for assessing CVD risk involving other health professionals, and decision aids that address the individuality of the patient’s health and environment, may support GPs in their decisions regarding CVD prevention.

  • general medicine (see internal medicine)
  • cardiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors IJ participated in the design of the search strategy, conducted the search, screened the studies, carried out thematic analysis and drafted the manuscript. AT designed the search strategy, participated in the thematic analysis and was the primary reviewer for the manuscript. EB, BC, AJ, JA, RJK, TU, KM, CSH, and JCC provided a critical review of the manuscript and provided final approval of the version to be published.

  • Funding The work was supported by a National Health and Medical Research Council of Australia Partnership Grant (1092674), including support from the National Heart Foundation of Australia. AT is supported by a NHMRC Fellowship (1106716).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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