Sustaining cardiovascular absolute risk management in Australian general practice

Abstract

This study describes the attitudes and practices of patients and GPs 12 months after participating in a trial of absolute cardiovascular risk assessment in general practice. It involved a qualitative design using semistructured interviews with 12 Sydney GPs from the intervention arm of a cluster randomised controlled trial of cardiovascular absolute risk (CVAR) assessment and 15 of their moderate to high risk patients who participated in the assessments. Most GPs had sustained CVAR assessment in their practice, using it primarily to motivate patients to change their behaviour and adhere to management rather than to make decisions about pharmacotherapy or referral. Time was a barrier to its use. Patients who sustained changes to their behaviour had internalised the benefits to their health and received support from family and friends. Those who relapsed attributed this to their own lack of motivation and extrinsic factors. CVAR assessment needs to be incorporated into practice information systems and long-term planned preventive care if it is to be sustained in general practice and have long-term impacts on patient behaviour.