Perspectives of older people engaging in nurse-led cardiovascular prevention programmes: a qualitative study in primary care in the Netherlands

Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

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Evaluation of Provider Implementation of the 2019 American College of Cardiology and American Heart Association Aspirin for Primary Prevention Guideline Recommendations for Older People

The Senior Care Pharmacist ◽

10.4140/tcp.n.2021.573 ◽

2021 ◽

Vol 36 (11) ◽

pp. 573-579

Author(s):

Caitlin S. Prather ◽

Erin N. Adams ◽

Whitney Zentgraf ◽

Jonathan Puhl ◽

Scott Barnett

Keyword(s):

Primary Care ◽

Primary Prevention ◽

Older People ◽

Primary Care Physicians ◽

American Heart Association ◽

American Heart ◽

Cardiovascular Prevention ◽

Heart Association ◽

Care Physician ◽

Smoking History

Design Retrospective chart review study using electronic medical record data from Inova Health System patients. Setting All cardiology, endocrinology, and primary care outpatient clinics operated by Inova Medical Group (IMG) in Northern Virginia. Participants Participants included were 70 years of age or older and taking aspirin 81 mg as of April 1, 2019. They had completed at least one visit with an IMG provider in primary care, cardiology, or endocrinology clinics between April 1, 2019, and February 17, 2020. Main Outcome Measures The primary outcome of this study was percentage of older people seen by a primary care physician, cardiologist, or endocrinologist since guideline publication who were continued on aspirin for primary prevention. Results The percentage of participants continued on aspirin for primary prevention was 92% versus 8.0% who were discontinued (P < 0.0001). Differences in subgroup analyses based on smoking history, diagnosis of diabetes, or history of venous thromboembolism were not statistically significant. Conclusion There was a significantly greater rate of aspirin continuation versus discontinuation among patients 70 years of age and older in the setting of primary cardiovascular prevention. Based on this result, most primary care physicians, endocrinologists, and cardiologists at this institution have chosen to continue aspirin in older people following the 2019 American College of Cardiology/American Heart Association guideline statement publication.

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GPs' perspectives on prescribing for older people in primary care: a qualitative study

British Journal of Clinical Pharmacology ◽

10.1111/bcp.13233 ◽

2017 ◽

Vol 83 (7) ◽

pp. 1521-1531 ◽

Cited By ~ 15

Author(s):

David O. Riordan ◽

Stephen Byrne ◽

Aoife Fleming ◽

Patricia M. Kearney ◽

Rose Galvin ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Older People

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Self-management and adherence with exercise-based falls prevention programmes: a qualitative study to explore the views and experiences of older people and physiotherapists

Disability and Rehabilitation ◽

10.3109/09638288.2013.797507 ◽

2013 ◽

Vol 36 (5) ◽

pp. 379-386 ◽

Cited By ~ 31

Author(s):

Lisa Robinson ◽

Julia L. Newton ◽

Diana Jones ◽

Pamela Dawson

Keyword(s):

Qualitative Study ◽

Older People ◽

Falls Prevention ◽

Self Management ◽

Prevention Programmes

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Gender differences within the barriers to smoking cessation and the preferences for interventions in primary care a qualitative study using focus groups in The Hague, The Netherlands

BMJ Open ◽

10.1136/bmjopen-2020-042623 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042623

Author(s):

Lieke Agathe Dieleman ◽

Petra G van Peet ◽

Hedwig M M Vos

Keyword(s):

Primary Care ◽

Gender Differences ◽

Smoking Cessation ◽

Qualitative Study ◽

The Netherlands ◽

Focus Groups ◽

Group Intervention ◽

Future Research ◽

The Hague ◽

Gender Specific

ObjectivesThis research aimed to provide a deeper insight into the gender-specific barriers to smoking cessation and gender-specific preferences for interventions in primary care, in order to contribute to better aligned cessation care for women.DesignQualitative study using focus groups.SettingRegularly smoking female and male adults were recruited from four different general practices in The Hague (The Netherlands).ParticipantsA total of 11 women and nine men participated. Participants included were regular smokers with a minimum age of 18 and sufficient command of the Dutch language, who were willing to talk about smoking cessation. Inclusion ended when saturation was reached for both women and men. Participants were selected by means of purposeful sampling, whereby looking at age, educational level and experience with quitting.ResultsThe main barriers to smoking cessation in women were psychological factors, such as emotion and stress, compared with environmental factors in men. Women indicated they were in need of support and positivity, and both women and men expressed the desire for assistance without judgement. Contrary to men, women were not drawn to restrictions and (dis)incentives.ConclusionWhen counselling smokers, in women the focus should be on perceived internal problems, as opposed to more external obstacles in men. Contrary to men, female smokers seem to prefer non-coercive interventions, such as a group intervention offering support and positivity. Future research should focus on these gender differences, and how they could improve treatment in primary care.

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Access to care: a qualitative study exploring the primary care needs and experiences of older people needing assistance with daily living

Australian Journal of Primary Health ◽

10.1071/py20180 ◽

2021 ◽

Author(s):

Marina Kunin ◽

Jenny Advocat ◽

Nilakshi Gunatillaka ◽

Grant Russell

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Older People ◽

Access To Care ◽

Daily Living ◽

Care Needs

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Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care

British Journal of General Practice ◽

10.3399/bjgp16x685681 ◽

2016 ◽

Vol 66 (649) ◽

pp. e540-e551 ◽

Cited By ~ 13

Author(s):

Judith Sinnige ◽

Joke C Korevaar ◽

Jan van Lieshout ◽

Gert P Westert ◽

François G Schellevis ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Qualitative Study ◽

Older People ◽

Management Strategy ◽

Medication Management ◽

Prescribing Behaviour

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Settings and stakeholders

ESC CardioMed ◽

10.1093/med/9780198784906.003.0786_update_001 ◽

2018 ◽

pp. 898-909

Author(s):

Christi Deaton ◽

Margaret Cupples ◽

Kornelia Kotseva

Keyword(s):

Public Health ◽

Cardiovascular Disease ◽

Primary Care ◽

Cardiovascular Prevention ◽

Well Being ◽

Care Community ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Prevention Programmes ◽

Acute Cardiovascular Event

Cardiovascular disease remains a leading cause of death and disability globally, and cardiovascular prevention should take place everywhere. Reducing the burden of cardiovascular disease requires a concerted effort in multiple settings (primary care, acute care, community, and home), and from multiple stakeholders such as government, public health, non-governmental organizations, healthcare, industry, and individuals. Primary care provides the majority of healthcare to populations, and is in an optimal position to screen and assess patients for cardiovascular risk and deliver cardiovascular prevention. Improving screening, risk assessment, and use of evidence-based guidelines requires collaboration between specialist cardiology services and primary care. Nurse-led and multiprofessional teams are effective in delivering prevention across a variety of settings. Prevention should be a priority prior to patient discharge from hospital following an acute cardiovascular event, and should encompass both medications and advice regarding lifestyle behaviours. Secondary prevention through specialized prevention programmes is needed by patients in order to reduce the risk of subsequent events. Cardiac rehabilitation is one of the most effective methods of delivering prevention and improving patient well-being following an acute event or procedure. There is a need to get more patients participating by using alternative methods of delivery and ensuring that women, older patients, and those with low fitness are encouraged and supported to attend. Stakeholders such as government, non-governmental organizations, and industry have important roles to play in improving public health. Healthcare providers should disseminate their research in lay language, and play a role in advising on and supporting public health measures.

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