Open AccessJournal Article
A qualitative study of barriers to the use of statins and the implementation of coronary heart disease prevention in primary care.
John Kedward,Lorraine Dakin +1 more
TLDR
There are complex barriers to statin prescribing and coronary prevention in general practice, which may explain some of the variation that exists, and further studies of patients' views of statins may provide more information.Abstract:
BACKGROUND: Statin prescribing to prevent coronary heart disease is well below recommended levels. Studies suggest that the prescribing behaviour of doctors may be the biggest factor in the wide variation in statin prescribing in general practice. Understanding doctors' perceptions offers some insight into why variation occurs. AIM: To understand general practitioners' (GPs') views about barriers to statin prescribing, statin prescribing guidelines, and the successes and barriers to coronary prevention in primary care. DESIGN OF STUDY: Qualitative analysis of semi-structured interviews. SETTING: General practices in mid and south Bedfordshire. METHOD: Interviews with 26 GPs. RESULTS: GPs spoke of a variety of barriers to initiating statin treatment specifically, and coronary heart disease prevention generally. Barriers to statin prescribing included: concerns about cost; increased workload and adherence to treatment; variation in treatment targets for lowering cholesterol; and concerns about medicalisation, lifestyle, and health behaviour. GPs found it difficult to prioritize patients for statin treatment, their statin treatment targets varied, and many found primary prevention risk assessment tools difficult to interpret. Coronary prevention was limited by practice space and organisational issues, by problems with recording and retrieval of electronic data, and by limited doctor and nurse time. GPs suggested that funded nurse time, nurse-led heart disease clinics, and better use of electronic data would improve primary care coronary prevention. CONCLUSION: There are complex barriers to statin prescribing and coronary prevention in general practice, which may explain some of the variation that exists. Further studies of patients' views of statins may provide more information. More resources, improved guidance, and better dissemination of guidance may only address some of the issues.read more
Citations
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Journal ArticleDOI
Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography.
Maria Rubio-Valera,Mariona Pons-Vigués,María Martínez-Andrés,Patricia Moreno-Peral,Anna Berenguera,Ana Fernández +5 more
TL;DR: The conceptual overview provided by this synthesis of qualitative research on barriers and facilitators identified by PC physicians and nurses resulted in the development of practical recommendations for the design of PP&HP in PC, however, the effectiveness of these recommendations needs to be demonstrated.
Journal ArticleDOI
Patients with elevated baseline liver enzymes do not have higher frequency of hepatotoxicity from lovastatin than those with normal baseline liver enzymes.
TL;DR: Significant hepatotoxicity from lovastatin was very infrequent in this study, and individuals with elevated baseline liver enzyme levels did not have higher frequency of Lovastatin hepatot toxicity than those with normal liver enzymes levels.
Journal ArticleDOI
Effects of berberine on lipid profile in subjects with low cardiovascular risk.
Giuseppe Derosa,Angela D'Angelo,Aldo Bonaventura,Lucio Bianchi,Davide Romano,Pamela Maffioli +5 more
TL;DR: Berberine is effective and safe to mildly improve lipid profile in subjects with low risk for cardiovascular disease and after the washout period, lipid profile improved both compared with the wash out period, and with placebo.
Journal ArticleDOI
Patient and physician related factors of adherence to evidence based guidelines in diabetes mellitus type 2, cardiovascular disease and prevention: a cross sectional study.
TL;DR: Guideline adherence in chronic care was relatively good in the study sample, but still leaving room for improvement, indicating the necessity to improve physician education, and patient involvement.
Journal ArticleDOI
The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review.
TL;DR: New Zealand and Australia lag behind the United Kingdom in practice nurse development and a modified realist review was used to synthesize research and policy documents relating to government policies pertaining to nurse-led care.
References
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Analysing qualitative data
TL;DR: Qualitative research produces large amounts of textual data in the form of transcripts and observational fieldnotes, and the systematic and rigorous preparation and analysis of these data is time consuming and labour intensive.
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Qualitative research in health care: Assessing quality in qualitative research
Nicholas Mays,Catherine Pope +1 more
TL;DR: Two views of how qualitative methods might be judged are outlined and it is argued that qualitative research can be assessed according to two broad criteria: validity and relevance.
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Philosophical Medical Ethics
TL;DR: In this paper, an introduction to philosophical medical ethics is given, along with a discussion of the Arthur case and its application in the field of medical ethics, including the principles of good character, integrity, and consent.
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Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care
TL;DR: Improved medical and lifestyle components of secondary prevention produced by nurse led clinics seem to lead to fewer total deaths and coronary events, and secondary prevention clinics should be started sooner rather than later.
Journal Article
Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners.
TL;DR: The overriding concern of doctors to preserve the doctor-patient relationship and the range of attitudes, perceptions and experiences of doctors that have a bearing on the decision to prescribe begin to explain the apparent irrationality of some general practitioner prescribing.
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