Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study

Helene Rianne Voogdt-Pruis (1) , George H.M.I. Beusmans (1) , Anton P.M. Gorgels (2) , Jan W van Ree (3)

1 Integrated Care
2 Cardiology
3 General Practice

Aim This paper reports on a study of the experiences of general practitioners and practice nurses implementing nurse-delivered cardiovascular prevention to high risk patients in primary care. Background Difficulties may arise when innovations are introduced into routine daily practice. Whether or not implementation is successful is determined by different factors related to caregivers, patients, type of innovation and context. Methods A qualitative study nested within a randomised trial (2006-2008) to evaluate the effectiveness of nurse-delivered cardiovascular prevention. Six primary health care centres in the Netherlands (25 general practitioners, 6 practice nurses) participated in the trial. Interviews were held on two occasions: at three and at 18 months after commencement of consultation. The first occasion was a group interview with six practice nurses. The second consisted of semi-structured interviews with one general practitioner and one practice nurse from each centre. Findings Main barriers to the implementation included: lack of knowledge about the guideline, attitudes towards treatment targets, lack of communication, insufficient coaching by doctors, content of life style advice. At the start of the consultation project, practice nurses expressed concern of losing nursing tasks. Other barriers were related to patients (lack of motivation), the guideline (target population) and organisational issues (insufficient patient recording and computer systems). Conclusions Both general practitioners and practice nurses were positive about nurse-delivered cardiovascular prevention in primary care. Nurses could play an important role in successive removal of barriers to implementation of cardiovascular prevention. Mutual confidence between care providers in the health care team is necessary.

Mots clés: Medicine

Helene Rianne Voogdt-Pruis, George H.M.I. Beusmans, Anton P.M. Gorgels, Jan W van Ree. Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study. Journal of Advanced Nursing, 2011, 67 (8), pp.1758. ⟨10.1111/j.1365-2648.2011.05627.x⟩. ⟨hal-00627154⟩