Abstract
BackgroundBy screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs’ reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care.MethodsA qualitative design based in a grounded theory approach was chosen in order to investigate this unexplored research area. Data collection was done using focus group interviews and data was analysed using a constant comparative method. Twenty-two GPs were interviewed in four focus groups.ResultsFindings showed that GPs perceived difficulties in prioritizing patients with an unhealthy lifestyle and described a lack of systematicity in their procedures, which complicated their clinical decisions concerning patients with stroke risk factors. The results showed a lack of systematic risk screening methods. Time constraints and the reimbursement system were described as hindering the preventive work.ConclusionThere is a need for a more proactive, transparent and systematic approach in the distribution of GPs’ time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved.
Highlights
By screening and modifying risk factors, stroke incidence can be reduced
The participants described that the patient’s complaint and certain symptoms directed the General practitioner (GP)’s thoughts toward increased risk; a complaint of a headache was exemplified as making the GP suspect hypertension. They described that sometimes an abnormal value appeared by chance (“en passant”) during an examination and the GP wanted to continue investigating: “It might be that they have an appointment for something completely different and we find high blood pressure or that you find atrial fibrillation or [several persons agree] or just “en passant” like that”
GPs in our focus groups requested a team-based approach to managing patients at risk, and the results showed a fragmented care of patients
Summary
By screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs’ reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care. Major modifiable risk factors for stroke are: smoking, hypertension, diabetes, excessive alcohol consumption, The Swedish guidelines for disease prevention propose lifestyle counselling and medical treatment of stroke risk factors [3]. In 75% of the patients with hypertension, actions were taken, but only in 54% where smoking was a risk factor. In Great Britain, only 64% of patients with a calculable risk of CVD or undergoing preventive
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