Lipid Management in Primary Care for Socioeconomically Disadvantaged Populations in Northern England: A Qualitative Study.

Abstract

People in low socioeconomic circumstances are more susceptible to dyslipidemia and cardiovascular disease than those living in more affluent populations. Limited healthcare access and low preventive care uptake widen health inequalities. Understanding how primary care can better serve socioeconomically disadvantaged communities is urgently needed. To explore lipid management delivery in socioeconomically disadvantaged areas and identify barriers and enablers for lipid optimization for socioeconomically disadvantaged populations. Individual semi-structured remote interviews with clinicians, purposively recruited from primary care practices serving extremely socioeconomically disadvantaged communities in Northern England, UK, who were involved in the delivery and organization of lipid management. Interviews were recorded, transcribed, and analyzed thematically following framework analysis. Fifteen interviews were undertaken. Five themes emerged: complex and multimorbid patients with competing priorities, limited access and follow-up to supporting services, being flexible and working beyond guidelines, high workload with inadequate staff support, and the need for care integrity and sustainable support. The findings of this study have been fed back to the delivery of the national program to improve cardiovascular health. Socioeconomically disadvantaged communities have complex health needs posing risks of multimorbidity but living with low health literacy, competing demands upon time, and financial constraints. Clinicians are willing to adapt services but a lack of guidance for care and funded services remains a significant barrier to targeted service delivery. Research is needed to inform the effectiveness and acceptability of interventions for lipid management tailored for those experiencing low socioeconomic disadvantage.