Leah Tuzzio1, Ellen S O'Meara2, Erika Holden2, Michael L Parchman2, James D Ralston2, Jennifer A Powell3, Laura-Mae Baldwin4. 1. Kaiser Permanente Washington Health Research Institute, Seattle, Washington. Electronic address: leah.tuzzio@kp.org. 2. Kaiser Permanente Washington Health Research Institute, Seattle, Washington. 3. Powell & Associates LLC, Asheville, North Carolina. 4. Department of Family Medicine, University of Washington, Seattle, Washington; Institute of Translational Health Sciences, University of Washington, Seattle, Washington.
Abstract
INTRODUCTION: Cardiovascular disease risk calculators can inform and guide preventive strategies and treatment decisions by clinicians and patients. However, their uptake in primary care has been slow despite the recommendation in national cardiovascular disease prevention guidelines. Identifying the barriers to the implementation of cardiovascular disease risk calculators is essential for promoting their adoption. METHODS: The authors qualitatively analyzed structured physician educator notes written during an outreach education intervention with 44 small- and medium-sized primary care clinics that participated in the Agency for Healthcare Research and Quality‒funded EvidenceNOW Healthy Hearts Northwest trial. The authors coded barriers to the implementation of cardiovascular disease risk calculation and aligned them to the Consolidated Framework for Implementation Research. RESULTS: The authors identified 13 barriers from the physician educators' notes. The majority (n=8, 62%) mapped to the framework's Inner Setting domain. The 5 most commonly noted barriers were (1) time constraints to use a calculator (N=23 clinics), (2) limitations to accessing a calculator or the necessary information to use a calculator (N=22 clinics), (3) no or minimal buy-in from clinicians or staff to use a calculator (N=19 clinics), (4) reported patient fear of side effects from statin medications or patient dislike of taking medications per the guidelines (N=17 clinics), and (5) lack of documented clinic workflow for using a calculator (N=16 clinics). CONCLUSIONS: To improve the uptake of cardiovascular disease risk calculation in primary care, future cardiovascular disease prevention and implementation research should consider tailoring interventions to the common barriers to implementing cardiovascular disease risk calculation. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02839382.
INTRODUCTION:Cardiovascular disease risk calculators can inform and guide preventive strategies and treatment decisions by clinicians and patients. However, their uptake in primary care has been slow despite the recommendation in national cardiovascular disease prevention guidelines. Identifying the barriers to the implementation of cardiovascular disease risk calculators is essential for promoting their adoption. METHODS: The authors qualitatively analyzed structured physician educator notes written during an outreach education intervention with 44 small- and medium-sized primary care clinics that participated in the Agency for Healthcare Research and Quality‒funded EvidenceNOW Healthy Hearts Northwest trial. The authors coded barriers to the implementation of cardiovascular disease risk calculation and aligned them to the Consolidated Framework for Implementation Research. RESULTS: The authors identified 13 barriers from the physician educators' notes. The majority (n=8, 62%) mapped to the framework's Inner Setting domain. The 5 most commonly noted barriers were (1) time constraints to use a calculator (N=23 clinics), (2) limitations to accessing a calculator or the necessary information to use a calculator (N=22 clinics), (3) no or minimal buy-in from clinicians or staff to use a calculator (N=19 clinics), (4) reported patient fear of side effects from statin medications or patient dislike of taking medications per the guidelines (N=17 clinics), and (5) lack of documented clinic workflow for using a calculator (N=16 clinics). CONCLUSIONS: To improve the uptake of cardiovascular disease risk calculation in primary care, future cardiovascular disease prevention and implementation research should consider tailoring interventions to the common barriers to implementing cardiovascular disease risk calculation. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02839382.
Authors: Pedro Ordunez; Carlos Tajer; Thomas Gaziano; Yenny A Rodríguez; Andrés Rosende; Marc G Jaffe Journal: Rev Panam Salud Publica Date: 2022-05-10
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