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Prevention in primary care: facilitators and barriers to transform prevention from a random coincidence to a systematic approach
Author(s) -
Vos Hedwig M. M.,
Adan Iris M. A.,
Schellevis François G.,
LagroJanssen Antoine L. M.
Publication year - 2014
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12108
Subject(s) - reimbursement , scale (ratio) , witness , primary prevention , nursing , medicine , psychology , medical education , health care , public relations , family medicine , political science , physics , disease , law , pathology , quantum mechanics
Rationale, aims and objectives The D utch general practitioner ( GP ) plays a substantial role in prevention. At the same time, many GP s hesitate to incorporate large‐scale cardiovascular risk management ( CVRM ) programmes into their daily practice. By exploring facilitators and barriers occurring during the past three decades, we wish to find clues on how to motivate professionals to adopt and implement prevention programmes. Methods A witness seminar was organized in S eptember 2011, inviting key figures to discuss the decision‐making process of the implementation of systematic prevention programmes in the N etherlands in the past, thereby adding new perspectives on past events. The extensive discussion was fully audiotaped. The transcript was content‐analysed. Results We came across four different transitional stages: (1) the conversion from GP s disputing prevention to the implementation of systematic influenza vaccination; (2) the transition from systematic influenza vaccination to planning CVRM programmes; (3) the transition from planning and piloting CVRM programmes to cancelling the large‐scale implementation of the CVRM programme; and (4) the reinforcement of prevention. Conclusions The GP s' fear to lose the domain of prevention to other health care professionals and financial and logistical support are the main facilitators for implementing prevention programmes in primary care. The main barriers for implementing prevention are the combination of insecurity about reimbursement and lack of scientific evidence. It appears that the ethical view of GP s that everyone should have the same right to obtain preventive care gradually takes over the inclination to hold on to evidence‐based prevention.