General practitioners' decision making about primary prevention of Cardiovascular Disease in older adults: A qualitative study

Jesse Jansen, Shannon McKinn, Carissa Bonner, Les Irwig, Jenny Doust, Paul Glasziou, Katy Bell, Vasi Naganathan, Kirsten J McCaffery

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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 susceptible to treatment harms. Moreover the potential benefits and harms of preventive medication 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. Transcribed 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.

Original languageEnglish
Article numbere0170228
JournalPLoS One
Volume12
Issue number1
DOIs
Publication statusPublished - 13 Jan 2017

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general practitioners
Primary Prevention
General Practitioners
cardiovascular diseases
decision making
Decision Making
Cardiovascular Diseases
disease prevention
Decision making
drug therapy
Comorbidity
Audio recordings
Nursing
nursing homes
Polypharmacy
Factor analysis
South Australia
New South Wales
Life Expectancy
Nursing Homes

Cite this

Jansen, Jesse ; McKinn, Shannon ; Bonner, Carissa ; Irwig, Les ; Doust, Jenny ; Glasziou, Paul ; Bell, Katy ; Naganathan, Vasi ; McCaffery, Kirsten J. / General practitioners' decision making about primary prevention of Cardiovascular Disease in older adults : A qualitative study. In: PLoS One. 2017 ; Vol. 12, No. 1.
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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 susceptible to treatment harms. Moreover the potential benefits and harms of preventive medication 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. Transcribed 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.",
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General practitioners' decision making about primary prevention of Cardiovascular Disease in older adults : A qualitative study. / Jansen, Jesse; McKinn, Shannon; Bonner, Carissa; Irwig, Les; Doust, Jenny; Glasziou, Paul; Bell, Katy; Naganathan, Vasi; McCaffery, Kirsten J.

In: PLoS One, Vol. 12, No. 1, e0170228, 13.01.2017.

Research output: Contribution to journalArticleResearchpeer-review

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