General practitioners’ decision making about primary prevention of cardiovascular disease in older adults: a qualitative study
Access status:
Open Access
Type
ArticleAuthor/s
Jansen, JesseMcKinn, Shannon
Bonner, Carissa
Irwig, Les
Doust, Jenny
Glasziou, Paul
Bell, Katy J.L.
Naganathan, Vasi
McCaffery, Kirsten
Abstract
Background: Primary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more sus- ceptible to treatment harms. Moreover the potential benefits and harms of preventive medi- ...
See moreBackground: Primary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more sus- ceptible to treatment harms. Moreover the potential benefits and harms of preventive medi- cation for older people are uncertain. We explored GPs’ decision making about primary CVD prevention in patients aged 75 years and older. Method: 25 GPs participated in semi-structured interviews in New South Wales, Australia. Tran- scribed audio-recordings were thematically coded and Framework Analysis was used. Results: Analysis identified factors that are likely to contribute to variation in the management of CVD risk in older people. Some GPs based CVD prevention on guidelines regardless of patient age. Others tailored management based on factors such as perceptions of prevention in older age, knowledge of limited evidence, comorbidities, polypharmacy, frailty, and life expectancy. GPs were more confident about: 1) medication and lifestyle change for fit/ healthy older patients, and 2) stopping or avoiding medication for frail/nursing home patients. Decision making for older patients outside of these categories was less clear. Conclusion: Older patients receive different care depending on their GP’s perceptions of ageing and CVD prevention, and their knowledge of available evidence. GPs consider CVD prevention for older patients challenging and would welcome more guidance in this area.
See less
See moreBackground: Primary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more sus- ceptible to treatment harms. Moreover the potential benefits and harms of preventive medi- cation for older people are uncertain. We explored GPs’ decision making about primary CVD prevention in patients aged 75 years and older. Method: 25 GPs participated in semi-structured interviews in New South Wales, Australia. Tran- scribed audio-recordings were thematically coded and Framework Analysis was used. Results: Analysis identified factors that are likely to contribute to variation in the management of CVD risk in older people. Some GPs based CVD prevention on guidelines regardless of patient age. Others tailored management based on factors such as perceptions of prevention in older age, knowledge of limited evidence, comorbidities, polypharmacy, frailty, and life expectancy. GPs were more confident about: 1) medication and lifestyle change for fit/ healthy older patients, and 2) stopping or avoiding medication for frail/nursing home patients. Decision making for older patients outside of these categories was less clear. Conclusion: Older patients receive different care depending on their GP’s perceptions of ageing and CVD prevention, and their knowledge of available evidence. GPs consider CVD prevention for older patients challenging and would welcome more guidance in this area.
See less
Date
2017-01-13Publisher
PLOSLicence
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Citation
Jansen J, McKinn S, Bonner C, Irwig L, Doust J, Glasziou P, Bell K, Naganathan V, McCaffery K. (2017) General practitioners’ decision making about primary prevention of cardiovascular disease in older adults: a qualitative study. PLoS ONE 12(1): e0170228Share