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Implementing cardiometabolic health checks in general practice: a qualitative process evaluation

机译：在一般实践中进行心脏代谢健康检查：定性过程评估

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Background A stepwise screening approach for the detection and management of cardiometabolic disease is proposed in various primary care guidelines. The aim of this study was to explore the implementation of a cardiometabolic health check as perceived by the involved caregivers and patients. Methods Qualitative process evaluation of the implementation of a cardiometabolic screening programme in a multidisciplinary primary healthcare centre in Eindhoven, the Netherlands, in which 1270 patients had participated. We explored the caregivers’ experiences though focus group discussions and collected patients’ experiences through a written questionnaire containing two open-ended questions. We analyzed our data using a thematic content analysis based on grounded theory principles. Results Five general practitioners, three practice nurses and five medical receptionists participated in the focus groups. Additionally we collected experiences of 657 (52% of 1270) participating patients through an open-ended questionnaire. GPs were enthusiastic about offering a health check and preferred systematic screening over case-finding, both in terms of yield and workload. The level of patient participation was high and most participants were enthusiastic about the health check being offered by their GP. Despite their enthusiasm, the GPs realized that they lacked experience in the design and implementation of a structured, large-scale prevention programme. This resulted in suboptimal instruction of the involved practice nurses and medical receptionists. The recruitment strategy was unnecessarily aggressive. There were shortcomings in communicating the outcomes of the health check to the patients and there was no predefined follow-up programme. Based on our findings we developed a checklist that can be used by designers of similar health checks. Conclusions A number of fundamental issues may arise when GPs organize a systematic screening programme in their practice. These issues are related to the preparation of the involved staff, the importance of integration with everyday clinical practice, the approach of healthy patients and the provision of adequate follow-up programmes. The identified challenges and recommendations can be taken into account during future screening programmes.
机译：背景技术在各种初级保健指南中提出了一种逐步筛选方法，用于检测和管理心脏代谢疾病。这项研究的目的是探索由相关护理人员和患者所感知的心脏代谢健康检查的实施。方法在荷兰埃因霍温的一个多学科基础医疗中心，对心脏代谢筛查计划的实施进行了定性过程评估，共有1270名患者参加。我们通过小组讨论探讨了护理人员的经验，并通过包含两个开放性问题的书面问卷收集了患者的经验。我们使用了基于扎根理论原理的主题内容分析来分析数据。结果5名全科医生，3名执业护士和5名医疗接待员参加了焦点小组。此外，我们通过开放式问卷调查收集了657名患者（1270名中的52％）的经验。在产量和工作量方面，全科医生都热衷于提供健康检查和优先进行系统的筛查，而不是寻找病例。患者的参与水平很高，大多数参与者对他们的全科医生提供的健康检查充满热情。尽管有热情，全科医生意识到他们缺乏设计和实施结构化的大规模预防计划的经验。这导致所涉及的执业护士和医疗接待员的指导不够理想。招聘策略不必要地激进。在向患者传达健康检查结果方面存在缺陷，并且没有预先确定的随访计划。根据我们的发现，我们制定了一个清单，可供类似健康检查的设计人员使用。结论当GP在实践中组织系统的筛查程序时，可能会出现许多基本问题。这些问题与参与人员的准备，与日常临床实践相结合的重要性，健康患者的方法以及提供适当的后续计划有关。在以后的筛选程序中可以考虑已识别的挑战和建议。

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