Journal Article

Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis

Aertgeerts, Bert, Vermandere, Mieke, Smeets, Miek, Van Roy, Sara, Vaes, Bert

2016

Overview

ObjectivesGeneral practitioners (GPs) play a key role in heart failure (HF) management. Despite multiple guidelines, the management of patients with HF in primary care is suboptimal. Therefore, all the qualitative evidence concerning GPs’ perceptions of managing HF in primary care was synthesised to identify barriers and facilitators for optimal care, and ideas for improvement.DesignQualitative evidence synthesis.MethodsSearches of MEDLINE, EMBASE, Web of Science and CINAHL databases up to 20/12/2015 were conducted. The Critical Appraisal Skills Programme's checklist for qualitative research was used for quality assessment. Thematic analysis was used as method of analysis.ResultsOf 5427 articles, 18 qualitative articles were included. Findings were organised in HF-specific factors, patient factors, physician factors and contextual factors. GPs’ uncertainty in all areas of HF management was highlighted. HF management started with an uncertain diagnosis, leading to difficulties with communication, treatment and advance care planning. Lack of access to specialised care and lack of knowledge were identified as important contributors to this uncertainty. In an effort to overcome this, strategies bringing evidence into practice should be promoted. GPs expressed the need for a multidisciplinary chronic care approach for HF. However, mixed experiences were noted with regard to interprofessional collaboration.ConclusionsThe main challenges identified in this synthesis were how to deal with GPs’ uncertainty about clinical practice, how to bring evidence into practice and how to work together as a multiprofessional team. These barriers were situated predominantly on the physician and contextual level. Targets to improve GPs’ HF care were identified.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Attitude of Health Personnel / Female / General practice / Family practice / General Practitioners - psychology / Heart Failure - mortality / Heart Failure - therapy / Humans / Male / Physician's Role / Primary Health Care - standards / Qualitative Research / Quality Improvement - standards / Quality of Health Care - standards / Referral and Consultation - statistics & numerical data