Kirsti Jakobs, Latoya Lautan, Peter Lucassen, Joost Janzing, Jan van Lieshout, Marion C J Biermans, Erik W M A Bischoff
{"title":"严重精神疾病或服用抗精神病药物患者的心血管风险管理:荷兰全科医生中障碍和促进因素的定性研究。","authors":"Kirsti Jakobs, Latoya Lautan, Peter Lucassen, Joost Janzing, Jan van Lieshout, Marion C J Biermans, Erik W M A Bischoff","doi":"10.1080/13814788.2022.2092093","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Cardiovascular risk management (CVRM) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in CVRM programmes in Dutch primary care is low.</p><p><strong>Objectives: </strong>To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme.</p><p><strong>Methods: </strong>In 2019, we conducted a qualitative study among 13 Dutch GPs. During individual in-depth, semi-structured interviews a computer-generated list of eligible patients who lacked annual cardiovascular risk (CVR) screening guided the interview. Data was analysed thematically.</p><p><strong>Results: </strong>The main barriers identified were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through a computer-generated list of eligible patients and (ii) involvement of family or carers.</p><p><strong>Conclusion: </strong>This study displays a range of barriers and facilitators anticipated by GPs. These indicate the preconditions required to remove barriers and facilitate GPs, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence and incentives for practices in deprived areas.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272927/pdf/","citationCount":"2","resultStr":"{\"title\":\"Cardiovascular risk management in patients with severe mental illness or taking antipsychotics: A qualitative study on barriers and facilitators among dutch general practitioners.\",\"authors\":\"Kirsti Jakobs, Latoya Lautan, Peter Lucassen, Joost Janzing, Jan van Lieshout, Marion C J Biermans, Erik W M A Bischoff\",\"doi\":\"10.1080/13814788.2022.2092093\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Cardiovascular risk management (CVRM) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in CVRM programmes in Dutch primary care is low.</p><p><strong>Objectives: </strong>To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme.</p><p><strong>Methods: </strong>In 2019, we conducted a qualitative study among 13 Dutch GPs. During individual in-depth, semi-structured interviews a computer-generated list of eligible patients who lacked annual cardiovascular risk (CVR) screening guided the interview. Data was analysed thematically.</p><p><strong>Results: </strong>The main barriers identified were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through a computer-generated list of eligible patients and (ii) involvement of family or carers.</p><p><strong>Conclusion: </strong>This study displays a range of barriers and facilitators anticipated by GPs. These indicate the preconditions required to remove barriers and facilitate GPs, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence and incentives for practices in deprived areas.</p>\",\"PeriodicalId\":54380,\"journal\":{\"name\":\"European Journal of General Practice\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272927/pdf/\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of General Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/13814788.2022.2092093\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of General Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/13814788.2022.2092093","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Cardiovascular risk management in patients with severe mental illness or taking antipsychotics: A qualitative study on barriers and facilitators among dutch general practitioners.
Background: Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Cardiovascular risk management (CVRM) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in CVRM programmes in Dutch primary care is low.
Objectives: To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme.
Methods: In 2019, we conducted a qualitative study among 13 Dutch GPs. During individual in-depth, semi-structured interviews a computer-generated list of eligible patients who lacked annual cardiovascular risk (CVR) screening guided the interview. Data was analysed thematically.
Results: The main barriers identified were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through a computer-generated list of eligible patients and (ii) involvement of family or carers.
Conclusion: This study displays a range of barriers and facilitators anticipated by GPs. These indicate the preconditions required to remove barriers and facilitate GPs, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence and incentives for practices in deprived areas.
期刊介绍:
The EJGP aims to:
foster scientific research in primary care medicine (family medicine, general practice) in Europe
stimulate education and debate, relevant for the development of primary care medicine in Europe.
Scope
The EJGP publishes original research papers, review articles and clinical case reports on all aspects of primary care medicine (family medicine, general practice), providing new knowledge on medical decision-making, healthcare delivery, medical education, and research methodology.
Areas covered include primary care epidemiology, prevention, diagnosis, pharmacotherapy, non-drug interventions, multi- and comorbidity, palliative care, shared decision making, inter-professional collaboration, quality and safety, training and teaching, and quantitative and qualitative research methods.