Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review

Wändell, Per; Waard, Anne-Karien M de; Holzmann, Martin J.; Gornitzki, Carl; Lionis, Christos; Wit, Niek de; Søndergaard, Jens; Sønderlund, Anders Larrabee; Král, Norbert; Seifert, Bohumil; Korevaar, Joke C.; Schellevis, François G.; Carlsson, Axel C.

doi:10.1093/fampra/cmx137

Cited by 67 publications

(117 citation statements)

References 54 publications

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“…Barriers related to the 'environmental context and resource' domain were most commonly reported, particularly a perceived lack of time to treat CKD in the primary healthcare setting [6,8,9,22,[26][27][28][29][30][31][32][33][34][35]. This finding aligns with previous systematic reviews relating to CKD specifically [11], and cardiometabolic diseases more broadly [38]. The presence of a high workload and limited time availability in primary care have been previously highlighted in the literature [39].…”

Section: Discussionsupporting

confidence: 73%

Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

2020

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Background: Chronic kidney disease (CKD) is growing population health concern worldwide, and with early identification and effective management, kidney disease progression can be slowed or prevented. Most patients with risk factors for chronic kidney disease are treated within primary healthcare. Therefore, it is important to understand how best to support primary care providers (PC-P) to detect and manage chronic kidney disease. The aim of this systematic review was to evaluate barriers and enablers to the diagnosis and management of CKD in primary care. Methods: A systematic review of qualitative research on the barriers and/or enablers to detection and/or management of CKD in adults within primary healthcare was conducted. The databases Medline (EBSCO), PubMed, Cochrane CENTRAL, CINAHL (EBSCO) and Joanna Briggs Institute Evidence Based Practice (Ovid) were searched until 27th August 2019. Barriers and/or enablers reported in each study were identified, classified into themes, and categorised according to the Theoretical Domains Framework. Results: A total of 20 studies were included in this review. The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the 'Environmental context and resources' domain (n = 16 studies). Overall, the most common barrier identified was a lack of time (n = 13 studies), followed by a fear of delivering a diagnosis of CKD, and dissatisfaction with CKD guidelines (both n = 10 studies). Overall, the most common enabler identified was the presence of supportive technology to identify and manage CKD (n = 7 studies), followed by the presence of a collaborative relationship between members of the healthcare team (n = 5 studies). Conclusion: This systematic review identified a number of barriers and enablers which PC-P face when identifying and managing CKD. The findings of this review suggest a need for time-efficient strategies that promote collaboration between members of the healthcare team, and practice guidelines which consider the frequently comorbid nature of CKD. Enhanced collaboration between PC-P and nephrology services may also support PC-Ps when diagnosing CKD in primary care, and facilitate improved patient self-management.

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Section: Discussionsupporting

confidence: 73%

Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

2020

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“…Thirteen systematic reviews highlighted healthcare professionals' perceived lack of support and resources to deliver behavior change interventions (Wandell et al 2018). Examples included a lack of staffing and support from more senior members of staff (Guydish et al 2007) and limited availability of educational materials to give to patients (Hebert et al 2012).…”

Section: Beliefs About Resources and Support Needed To Facilitate Intmentioning

confidence: 99%

Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews

et al. 2020

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Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals' (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers:(1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals' own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals' delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.

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“…This study was performed in an urban setting in a high‐income country with a publicly funded health system. Any attempt to generalize the findings to another setting would have to take into account the healthcare organization of that particular setting, as was concluded in a recent review about prevention of cardiometabolic diseases in primary care …”

Section: Discussionmentioning

confidence: 99%

Secondary prevention after stroke/transient ischemic attack: A randomized audit and feedback trial

et al. 2019

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Objectives:The clinical benefits of use of secondary preventive pharmacotherapy in ischemic stroke/TIA have been previously demonstrated. A potential target for facilitating the use of recommended medications is primary care physicians.Therefore, we carried out an audit and feedback intervention aimed at primary care centers. The aim was to improve the use of secondary preventive stroke medications and diagnosis recording in ischemic stroke/TIA. Materials and Methods:The intervention consisted of structured, healthcare database-derived quality reports on secondary preventive medication use and diagnosis recording, sent in 2015 to half of the primary care centers in Stockholm County, with information specific to each primary care center. Medication dispensation (primary outcome) for statins, antihypertensives, antiplatelets, and anticoagulants, as well as diagnosis recording (secondary outcome), was compared between intervention centers and control centers in the 18 months following the intervention. Outcome data were derived from the healthcare databases of Stockholm County (VAL). Results:Dispensation of medications to the 12 766 patients analyzed in the study was high. Over 77% of patients used antihypertensives and antithrombotics, and 65%-68% used statins. After the intervention, no differences in medication dispensation were seen between the intervention and control centers, even after adjusting for potential confounders. Conclusions:A simple audit and feedback intervention directed toward physicians in primary care did not improve medication dispensation to ischemic stroke/TIA patients 18 months later. Any future audit and feedback intervention aimed at improving adherence to guidelines for secondary prevention in primary care should consider multiple and continuous reminders, the graphical appeal, and widening the recipients to include patients. K E Y W O R D Sdiagnosis recording, drug therapy, general practitioners, transient ischemic attack, physicians, primary care, primary health care, secondary prevention, stroke

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Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review

Cited by 67 publications

References 54 publications

Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews

Secondary prevention after stroke/transient ischemic attack: A randomized audit and feedback trial

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