Prevention in primary care: facilitators and barriers to transform prevention from a random coincidence to a systematic approach

Abstract

The Dutch general practitioner (GP) plays a substantial role in prevention. At the same time, many GPs hesitate to incorporate large-scale cardiovascular risk management (CVRM) programmes into their daily practice. By exploring facilitators and barriers occurring during the past three decades, we wish to find clues on how to motivate professionals to adopt and implement prevention programmes. A witness seminar was organized in September 2011, inviting key figures to discuss the decision-making process of the implementation of systematic prevention programmes in the Netherlands in the past, thereby adding new perspectives on past events. The extensive discussion was fully audiotaped. The transcript was content-analysed. We came across four different transitional stages: (1) the conversion from GPs disputing prevention to the implementation of systematic influenza vaccination; (2) the transition from systematic influenza vaccination to planning CVRM programmes; (3) the transition from planning and piloting CVRM programmes to cancelling the large-scale implementation of the CVRM programme; and (4) the reinforcement of prevention. The GPs' fear to lose the domain of prevention to other health care professionals and financial and logistical support are the main facilitators for implementing prevention programmes in primary care. The main barriers for implementing prevention are the combination of insecurity about reimbursement and lack of scientific evidence. It appears that the ethical view of GPs that everyone should have the same right to obtain preventive care gradually takes over the inclination to hold on to evidence-based prevention.