Family Practice Vol. 19, No. 6, 605-610
© Oxford University Press 2002
‘I saw the panic rise in her eyes, and evidence-based medicine went out of the door.’ An exploratory qualitative study of the barriers to secondary prevention in the management of coronary heart disease
a GP, Saintbridge Surgery, Askwith Road, Gloucester and
b Department of Social Medicine, University of Bristol, Bristol, UK.
Catherine Pope, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK; E-mail: c.pope{at}bristol.ac.uk
Background. Coronary heart disease (CHD) is the leading cause of death in the UK, yet only 50% of CHD patients receive appropriate secondary prevention.
Objectives. To explore GP attitudes to evidence about CHD, and to identify factors influencing the implementation of secondary prevention in GP consultations.
Methods. Semi-structured interviews and focus groups exploring consultations with patients previously diagnosed as having CHD.
Results. Use of evidence is influenced by credibility. Lack of time was the greatest barrier to accessing evidence and to implementing secondary prevention. Patients were more likely to receive secondary prevention in a dedicated clinic. Patient characteristics including physical and mental co-morbidity mitigate against secondary prevention. GPs experienced difficulty balancing implementation of evidence with the demands of the doctor–patient relationship.
Conclusions. The doctor–patient relationship may act as a barrier to the delivery of secondary prevention in primary care. It may be time to re-evaluate models of these relationships and reconsider the strategies for implementing evidence.
Keywords. Doctor–patient relationship, evidence-based medicine, guidelines, qualitative research, secondary prevention of coronary heart disease.
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