From reactive to proactive preventive cardiovascular risk management in primary care: a feasibility study

Background Empanelment – identification and systematic categorization of patients sharing the same risk for cardiovascular disease (CVD) in primary care – provides the opportunity to tailor preventive treatment strategies to the care needs of individual patients in a proactive manner. It might provide opportunities to allocate resources to alleviate the disease burden for patient and society. In practice however, interventions using routinely collected health care data for proactive risk stratification are challenging to develop and implement. These challenges are related to practical constraints such as high safety and availability demands of data infrastructure, quality of the health care data and heterogeneity in the population working with the intervention – relating to both patients and health care professionals (HCPs). Purpose The overall aim of the feasibility study was to assess health care professionals' attitudes towards implementation of the PROSPERA-tool: a multilevel guideline adherence tool directed at an organizational change towards proactive cardiovascular risk management in primary care on both a population- and individual patient level. Methods This study was designed as a qualitative study using consecutive focus group sessions to assess the feasibility, acceptability, usability and appropriateness of the PROSPERA-tool as perceived by HCPs in primary care in the Netherlands. Constructs of the Theoretical Domain Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) were used for the focus group topic guide and thematic analysis. Results In total 9 HCP (4 practice nurses, 5 general practitioners) participated in four consecutive focus groups. Preliminary results included major facilitators identified in the increased insight that was provided to the HCPs in their cardiovascular population and the possibility of time allocation between well-controlled and poor-controlled patients. Other facilitators were found in the design of parts of the PROSPERA-tool and in external support in learning how to work with the tool. Main identified barriers were changing professional roles (‘letting go of the driver’s seat’) and fear of degradation of the confiding doctor-patient relationship. Other barriers were related to routines and the concern of having insufficient (digital) skills to work with the PROSPERA-tool. Conclusions Various facilitators and barriers were identified for implementation of the PROSPERA-tool in the workflow of HCPs. This highlights the importance for implementation strategies matched to the identified barriers. Attention should be paid to preservation of the doctor-patient relationship, the construction of a safety net, and a supportive environment including training for HCPs with the opportunity for skill-improvement.