From: Views on primary prevention of cardiovascular disease - an interview study with Swedish GPs
RELIANCE | Fields of agreement | |
---|---|---|
Too difficult and inappropriate to give the patient a numerical estimate of cardiovascular risk or risk score; more important to treat hypertension than hyperlipidaemia pharmaceutically; lifestyle intervention is more important for younger people; reduced drug prices influence prescribing criteria; individualization of advice and treatment is necessary; testing and prescribing drugs without proper indication can make patients feel ill | ||
Fields of variation | ||
1. Trust in pharmaceutical prevention | A. Firm trust in effectiveness and cost-effectiveness of pharmaceutical prevention | |
B. Some doubts about the effectiveness for the individual patient | ||
C. Expressed doubts due to insufficient evidence | ||
2. Trust in non-pharmaceutical prevention | A. Non-pharmaceutical treatment is the basis | |
B. Non-pharmaceutical treatment is too difficult to carry out and not very effective | ||
C. Non-pharmaceutical treatment is not effective and it impairs the quality of life for the patients | ||
3. Importance of a treatment goal | A. A pre-defined target is necessary | |
B. The importance of a target is varying: important for high-risk patients but not for low-risk patients | ||
C. The lowering of blood-pressure or lipids is the most important, not to a certain value | ||
4. Pharmaceutical prevention for different ages | A. More important for younger individuals | |
B. Equally important for young and old | ||
C. More important for older individuals | ||
RESPONSIBILITY | Fields of agreement | |
Genetic disposition is a significant risk factor; the "western" lifestyle causes cardiovascular disease; smoking is the most important lifestyle risk factor; a positive expectation that the intervention is beneficial is a necessary condition for compliance | ||
Fields of variation | ||
1. Information regarding potential adverse effects and length of treatment | A. Important to inform for the patient to be prepared and feel safe | |
B. Avoiding information is better, not to worry the patient | ||
2. Treatment decision | A. The doctor has the main responsibility | |
B. A decision on equal terms is preferred | ||
C. The patient has the main responsibility | ||
3. The role of the doctor in non-pharmaceutical treatment | A. The doctor's role is to confront the patient with uncomfortable recommendations and make demands on the patient | |
B. The doctor's role is to communicate a positive message and encourage every little step the patient takes towards a healthier lifestyle | ||
C. It is too difficult for the doctor to talk about lifestyle risk factors without blaming or burdening the patient. The doctor has no important role in non-pharmaceutical treatment | ||
D. The doctor has no right to demand a change in the patient's lifestyle, but should instead prescribe pharmaceuticals for smokers and over-weight people |