Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Psychiatry, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
Eur J Gen Pract. 2022 Dec;28(1):191-199. doi: 10.1080/13814788.2022.2092093.
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.
To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme.
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.
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.
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.
患有严重精神疾病（SMI）或接受抗精神病药物（APs）治疗的患者心血管疾病风险增加。由于精神保健从二级保健向初级保健转移，以及非适应证 AP 处方的增加，心血管风险管理（CVRM）越来越依赖全科医生（GPs）。然而，荷兰初级保健中接受 SMI/AP 患者参加 CVRM 项目的比例很低。
探讨全科医生在现有 CVRM 计划中纳入和治疗 SMI 或使用 APs 的患者时预见的障碍和促进因素。
2019 年，我们对 13 名荷兰全科医生进行了一项定性研究。在个体深入、半结构化访谈中，计算机生成的一份符合条件的患者名单，这些患者缺乏年度心血管风险（CVR）筛查，指导了访谈。数据进行了主题分析。
确定的主要障碍包括：（i）低估患者的 CVR 和对应用降低风险策略（如戒烟）的犹豫不决，（ii）贫困地区 GP 负担不成比例，（iii）GP 和精神科医生之间信息交流不畅，以及（iv）对患者依从性的怀疑，特别是那些病情较复杂的患者。主要的促进因素包括：（i）通过符合条件的患者计算机生成名单为 GP 提供支持，以及（ii）家庭成员或照顾者的参与。
本研究展示了全科医生预期的一系列障碍和促进因素。这些表明了消除障碍和促进全科医生的前提条件，即实践指南中提供充分的建议、改善与精神科医生的咨询机会、提供支持患者依从性的实用建议以及为贫困地区的实践提供激励措施。
