Cardiovascular risk management in patients with severe mental illness or taking antipsychotics: A qualitative study on barriers and facilitators among dutch general practitioners

Abstract

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.

Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment

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Coronary Artery Disease in Patients with Severe Mental Illness

“…• Socioeconomic factors, such as social isolation and deprivation, may be relevant. 42 Indeed, social isolation highlights the importance of involving relatives and carers of patients with SMI wherever appropriate, and is considered to be a key facilitator in providing effective care by general practitioners. 42 • System factors include misattribution of physical symptoms to the primary psychiatric disease.…”

“…42 Indeed, social isolation highlights the importance of involving relatives and carers of patients with SMI wherever appropriate, and is considered to be a key facilitator in providing effective care by general practitioners. 42 • System factors include misattribution of physical symptoms to the primary psychiatric disease. 43 There may be difficulty obtaining high-quality cardiac investigations on patients admitted to psychiatric institutions and/or relative inexperience or underconfidence of psychiatrists in interpreting clinical data from such investigations.…”

Transmural collaborative care model for the review of antipsychotics: a feasibility study of a complex intervention

“…In many countries, such as the UK and the Netherlands, in primary care, chronic disease management programs have been developed for CVR management (CVRM) 12,13 . In these programs, trained nurses help patients to reduce CVR with lifestyle interventions and medication.However, patients on APs are rarely included in CVRM programs 14,15 . In our earlier study, examining the facilitators and barriers for CVRM for patients with severe mental illness (SMI) and/or APs, GPs mentioned several barriers, including a lack of awareness of the elevated risk, reluctance to invite these patients to their program as this could be complicated and time-consuming, and low expectations on the capability of these patients to develop a healthy lifestyle 14 .…”