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)
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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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