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Abstract
Cardiovascular absolute risk (CVAR) assessment, which involves estimation of the probability of developing a cardiovascular event over time based on assessment of multiple risk factors, has been recommended by many clinical guidelines to improve cardiovascular disease (CVD) primary prevention. However, a lack of implementation strategies has hindered widespread translation of the guidelines into practice and little research has been conducted on developing and testing implementation strategies. The aim of this research was to develop an implementation model of CVAR assessment and management in Australian general practice. It consisted of development and feasibility studies, which were carried out in three phases.
In Phase 1, I conducted focus groups and interviews to explore the views of general practitioners (GPs), patients and key informants on how the CVAR assessment and management should be implemented. My themes were based on a literature review, research done in preparation for this study, and relevant theoretical models. Key findings were used to develop a multi-strategy CVAR implementation model encompassing appropriate patient selection and preparation as well as the conduct of appropriate CVAR assessment and management.
In Phase 2, using mixed methods research, I explored the application of the model and its impact on GPs and patients. This confirmed that appropriate patient selection, use of a patient self-assessment (SA) form, electronic CVAR calculator and management guideline, length of consultation, and training of GPs to develop skills in communicating CVAR results and in shared decision making (SDM) were important in improving CVAR assessment and management, and supporting patient involvement and active self-management.
In Phase 3, using mixed methods research (including consultation recording analysis), I focused on the detailed process and content of CVAR consultations. This showed that at least 15 minutes’ consultation may be necessary. Quantifying the CVAR score using an electronic calculator was important to help motivate patients. Greater emphasis was needed in GP training on use of the patient SA form, SDM and intensification of medications and referrals in response to patient's high CVAR. Barriers to referral also need to be addressed.
This research demonstrated that the proposed implementation model was feasible in promoting the better use of CVAR assessment and management. This has important implications for future research, practice and policy. Further research is needed to investigate the effectiveness of the proposed model in reducing CVD risk and improving clinical outcomes and its applicability in other cultures and contexts.