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

Authors

  • Helene R. Voogdt-Pruis,

    1. Helene R. Voogdt-Pruis MSc PhD Researcher Department of Integrated Health Care, Maastricht University Medical Centre/CAPHRI, The Netherlands
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  • George H.M.I. Beusmans,

    1. George H.M.I. Beusmans MD PhD Asscociate Professor of General Practice Department of Integrated Health Care and Department of General Practice, Maastricht University Medical Centre/CAPHRI, The Netherlands
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  • Anton P.M. Gorgels,

    1. Anton P.M. Gorgels MD PhD Professor of Integrated Cardiology Department of Cardiology and Care and Public Health Research Institute, Maastricht University Medical Centre/CAPHRI, The Netherlands
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  • Jan W. van Ree

    1. Jan W. van Ree MD PhD Professor of General Practice Department of General Practice and Care and Public Health Research Institute, Maastricht University Medical Centre/CAPHRI, The Netherlands
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H.R Voogdt-Pruis: e-mail: hrvoogdt@gmail.com

Abstract

voogdt-pruis h.r., beusmans g.h.m.i., gorgels a.p.m. & van ree j.w. (2011) Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study. Journal of Advanced Nursing 67(8), 1758–1766.

Abstract

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 in a randomized 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 3 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 organizational 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 healthcare team is necessary.

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