Increased knowledge makes a difference! – general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial

Abstract

Objectives To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors. Design, setting and subjects Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis. Results Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result – A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action. Conclusion and implications Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures. Trial registration https://clinicaltrials.gov/ct2/show/NCT01849575 . KEY POINTS Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention: •Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measures •GPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-making •GPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis

The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk: Results from the VIPVIZA randomized clinical trial

“…Furthermore, the increased intervention effect noticed between 1 and 3 years with a further reduction in total cholesterol and LDL-cholesterol (mmol/L) is important. This may partly be explained by the increased awareness of handling the VIPVIZA result over time, by both physicians and participants [21] . This phenomenon may be explained by a gradual implementation and acceptance of VIPVIZA intervention by physicians as motivated by the diffusion of innovation model in which different categories of adopters are identified including the early adopters and late laggards [22] .…”

Time to initiation of lipid-lowering drugs for subclinical atherosclerosis: sub-study of VIPVIZA randomized controlled trial, with single-arm cross-over

“…The pictorial information gives a more intuitive understanding of CVD risk as found in an interview study with physicians. 5 The physicians experienced that with the pictorial information their risk assessment and patients’ risk perception were more accurate. Also, the intervention facilitated shared decision-making since study participants were better informed about atherosclerosis and more motivated to CVD prevention.…”

“…This effect was also described in the previous evaluation of the first 465 days after the ultrasound examination 8 and was observed during interviews with physicians between 2014 and 2016. 5 The compiled information from VIPVIZA makes the indications for treatment more accessible for both physicians and participants, making it more likely to seek consultation of physician from the participants side and easier for the physician to access and communicate the indication for treatment. 4 , 5 , 8 At the same time, a higher propensity among physicians to prescribe statins to these asymptomatic participants over time may also be due to a shift in the healthcare professionals’ attitude towards the treatment over time.…”

Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis: a qualitative study within the VIPVIZA trial

“…Atherosclerosis screening with ultrasound is non-invasive, and can be accessible also at long distances from hospitals (small portable machines), which enables population screening. Furthermore, atherosclerosis screening can be used as part of risk communication [ 9 , 10 ].…”