Implementing cardiometabolic health checks in general practice: a qualitative process evaluation

Abstract

BackgroundA stepwise screening approach for the detection and management of cardiometabolic disease is proposed in various primary care guidelines. The aim of this study was to explore the implementation of a cardiometabolic health check as perceived by the involved caregivers and patients.MethodsQualitative process evaluation of the implementation of a cardiometabolic screening programme in a multidisciplinary primary healthcare centre in Eindhoven, the Netherlands, in which 1270 patients had participated. We explored the caregivers’ experiences though focus group discussions and collected patients’ experiences through a written questionnaire containing two open-ended questions. We analyzed our data using a thematic content analysis based on grounded theory principles.ResultsFive general practitioners, three practice nurses and five medical receptionists participated in the focus groups. Additionally we collected experiences of 657 (52% of 1270) participating patients through an open-ended questionnaire.GPs were enthusiastic about offering a health check and preferred systematic screening over case-finding, both in terms of yield and workload. The level of patient participation was high and most participants were enthusiastic about the health check being offered by their GP. Despite their enthusiasm, the GPs realized that they lacked experience in the design and implementation of a structured, large-scale prevention programme. This resulted in suboptimal instruction of the involved practice nurses and medical receptionists. The recruitment strategy was unnecessarily aggressive. There were shortcomings in communicating the outcomes of the health check to the patients and there was no predefined follow-up programme. Based on our findings we developed a checklist that can be used by designers of similar health checks.ConclusionsA number of fundamental issues may arise when GPs organize a systematic screening programme in their practice. These issues are related to the preparation of the involved staff, the importance of integration with everyday clinical practice, the approach of healthy patients and the provision of adequate follow-up programmes. The identified challenges and recommendations can be taken into account during future screening programmes.

Selective prevention of cardiometabolic diseases: activities and attitudes of general practitioners across Europe

“…This is in agreement with previous findings 14 . A previous study showed that GPs were enthusiastic about offering health checks for CMD, and that they preferred systematic screening to case-finding 15 . This indicates that motivated GPs can play a key role in selective prevention programmes.…”

Experiences of patients and healthcare professionals of NHS cardiovascular health checks: a qualitative study

“… 22 , 23 Previous research has identified the importance of HCPs interpreting and communicating results and information on risk, clearly and to ensure that it is personalized. 6 , 24 , 25 Previous findings also reported that some patients sometimes found their QRisk2 score confusing and that it held no meaning or significance to them. 6 , 16 , 26 There are potential limitations in relying on risk score as a trigger for facilitating behaviour change.…”

“…21 There are conflicting findings on the impact of attending preventative programmes. 21 , 22 , 25 Some studies report that patients sometimes experience anxiety and stress associated with the receipt of negative or high-risk results 21 , 25 whilst others found no associated harms from attending CVD checks. 22 …”

Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

“…With this approach, we have tackled some earlier identified challenges such as good preparation of involved staff and the integration of the program within everyday practice. 21 Another strength was that we were able to collect the EHR data of 97% of the patients, instead of the anticipated 90%. 15 The small number of missing data (3%) was equally distributed among patients of different risk categories and therefore we assume these data were missing at random and did not influence our results.…”