Prerequisites for implementing cardiovascular absolute risk assessment in general practice: a qualitative study of Australian general practitioners' and patients' views

Background Although recommended in clinical practice guidelines, cardiovascular absolute risk (CVAR) assessment is still used infrequently in Australian general practice. One reason is the lack of an implementation strategy. Given the lack of published reports on the implementation of CVAR worldwide, the aim of this study was to explore the views of general practitioners (GPs) and patients on prerequisites for successfully implementing CVAR assessment in general practice. Methods Multiple data involving GPs and patients were collected using focus groups (FGs) in three divisions of General Practice in Sydney between 2005 and 2006. Both GPs' and patients' opinions were analysed using thematic analysis. Results Twenty-two GPs participated in three GP FGs and 26 patients in three patient FGs. Many GPs thought that an initial cardiovascular risk screening could start from 40 years old while some patients thought it should start even younger. Targeting patients with known risk factors was supported by most GPs although some also stressed the importance of reaching those of unknown risk. For new patients or patients presenting for other problems, another visit for CVAR risk assessment and discussion was preferred by most GPs. A strong GP-patient relationship, common ground on priorities between GPs and their patients, patient awareness of cardiovascular risk and motivation were seen as important by both GPs and patients to the implementation of CVAR assessment. Conclusions Addressing the appropriate selection of patients and time for implementing CVAR assessment requires a consideration of multiple factors. GPs see it as a process that may need to be staged over more than one consultation and requiring appropriate strategies.