James Hickling1, Stephen Rogers, Irwin Nazareth. 1. Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London. james.hickling@gp-F83063.nhs.uk
Abstract
BACKGROUND: Treating hypercholesterolaemia in patients with ischaemic heart disease can significantly reduce vascular deaths and events. Many such patients, however, do not receive effective treatment for hypercholesterolaemia. AIM: To ascertain the barriers to the detection and treatment of hypercholesterolaemia in patients with ischaemic heart disease as seen by primary care teams. DESIGN OF STUDY: Qualitative study using the nominal group technique. SETTING: General practice teams in the North Thames region of the Medical Research Council General Practice Research Framework. METHOD: The main outcomes measures used were identification of the barriers to the detection and treatment of hypercholesterolaemia together with relative rankings. RESULTS: Fourteen individual barriers were identified. The main barriers were: organisational barriers within general practices; confusing and conflicting guidelines from external sources; errors and omissions by GPs; communication problems at the interface between secondary and primary care; and reluctance by patients to take medication. CONCLUSIONS: The reasons for suboptimal detection and treatment of hypercholesterolaemia are complex and act at various levels. Interventions to improve the management of this condition must address these barriers in order to be successful.
BACKGROUND: Treating hypercholesterolaemia in patients with ischaemic heart disease can significantly reduce vascular deaths and events. Many such patients, however, do not receive effective treatment for hypercholesterolaemia. AIM: To ascertain the barriers to the detection and treatment of hypercholesterolaemia in patients with ischaemic heart disease as seen by primary care teams. DESIGN OF STUDY: Qualitative study using the nominal group technique. SETTING: General practice teams in the North Thames region of the Medical Research Council General Practice Research Framework. METHOD: The main outcomes measures used were identification of the barriers to the detection and treatment of hypercholesterolaemia together with relative rankings. RESULTS: Fourteen individual barriers were identified. The main barriers were: organisational barriers within general practices; confusing and conflicting guidelines from external sources; errors and omissions by GPs; communication problems at the interface between secondary and primary care; and reluctance by patients to take medication. CONCLUSIONS: The reasons for suboptimal detection and treatment of hypercholesterolaemia are complex and act at various levels. Interventions to improve the management of this condition must address these barriers in order to be successful.
Authors: Julia Langham; Helen Tucker; David Sloan; Jane Pettifer; Simon Thom; Harry Hemingway Journal: Br J Gen Pract Date: 2002-10 Impact factor: 5.386
Authors: Joshua S Benner; Robert J Glynn; Helen Mogun; Peter J Neumann; Milton C Weinstein; Jerry Avorn Journal: JAMA Date: 2002 Jul 24-31 Impact factor: 56.272
Authors: Steven M Handler; Subashan Perera; Ellen F Olshansky; Stephanie A Studenski; David A Nace; Douglas B Fridsma; Joseph T Hanlon Journal: J Am Med Dir Assoc Date: 2007-10-22 Impact factor: 4.669
Authors: Sara M Sarasua; Jiexiang Li; German T Hernandez; Keith C Ferdinand; Jonathan N Tobin; Kevin A Fiscella; Daniel W Jones; Angelo Sinopoli; Brent M Egan Journal: J Clin Hypertens (Greenwich) Date: 2017-05-07 Impact factor: 3.738
Authors: Alejandra Paniagua-Avila; Meredith P Fort; Russell E Glasgow; Pablo Gulayin; Diego Hernández-Galdamez; Kristyne Mansilla; Eduardo Palacios; Ana Lucia Peralta; Dina Roche; Adolfo Rubinstein; Jiang He; Manuel Ramirez-Zea; Vilma Irazola Journal: Trials Date: 2020-06-09 Impact factor: 2.279