| Abstract |
Background: Cardiovascular Disease (CVD) is one of the dominant causes of death worldwide. The scientific field has prioritized its research to the clinical practice of General Practicioners (GPs) in Primary Health Sector (PHC), as a modifiable factor that affects the implementation of prevention tools for CVD in PHC.
Aim: This study aims to research the level of implementation of prevention tools for CVD by GPs in PC and possible determinants that influence that use.
Methods/ Design: A mixed methodology study occurring in GPs, who work in rural public PHC units, in Heraklion, Crete, Greece. Τhe qualitative study was designed according to methodology of Theory of Planned Behaviour (TPB). Through purposive sampling, 3 GPs participated in a focus group as for the implementation of prevention tools for CVD. The data were thematically analyzed resulting in main themes, which were included into the questionnaire of the following cross sectional study. In terms of this, GPs who participated through opportunistic sampling, were questioned about their demographic features, their employment, the health profile, the familiarization with the guidelines of CVD prevention and their behavior according to the implementation of preventive tools of CVD in PHC. The last one was evaluated both directly by the participants and indirectly by application of qualitative study’s themes. Descriptive statistical analysis was used for the data analysis. Absolute and relative frequencies are provided for the qualitative variables, whereas mean and standard deviation for the quantitative ones. ANOVA, independent samples’ t-test, chi-square test were conducted, while also Pearson’s correlation coefficient (Pearson’s r) for the univariate correlations between variables and multivariate regression models. Results: By the qualitative survey and according to the GPs’ opinion, the implementation of prevention tools of CVD 1. is considered i) to reduce the total burden to patients, professionals and health system, ii) promotes the implementation of lege artis medical practice, iii) is limited by the insufficient training, 2. is affected by social pressure delivered by i) collegues, ii) patients, iii) guidelines, 3. depends on their perceived effectiveness, which is influenced by i) the training level and ii) the presence of an organized institutional framework. At the quantitative survey, 133 GPs were invited while 48 of them participated, with majority of female (n= 29, 60.4%), age between 25- 40 yo (n=25, 52.1%) and cooperating with less than one nurse (58.3%). Almost all participants (97.9%) acknowledge the General (Family) Medicine as the most responsible for the primary prevention of CVD, based on ESC/ AHA guidelines (87.5%) and mainly with the HEART Score (64.6%). All components of TPB had positive tendency, when participants evaluated directly their own behavior. As for the indirect measurements, the perceived behavioral control had positive result (m= 5.04, sd= 1.07), while attitude and subjective norms had negative values (m= -23.94 and -6.14, respectively). The participants, who are affected by their subjective norms, had lower probability (OR= 0.3666, 95%CI-0.138-0.970) to use other digital applications for the CVD prevention, apart from those available from the competent agencies, oppositely to those who feel able to enact this behavior who had higher probability (OR=2.144, 95%CI=1.093-4.207). Only the perceived behavioral control was found to influence the intention of implementation of prevention tools of CVD in next 10 patients, with statistical significance (pvalue<0.001).
Conclusion:
The survey’s results indicate that the level of control that GPs feel they have in order to imply prevention tools of CVD in PHC is correlated to the training level and the presence of an organized institutional framework. Furthermore it seems to affect positively their intention to use these tools, highlighting this way a possible field for further research and interventions, in order to improve the primary prevention of CVD.
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