Abstract Body

Background and purpose

Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Annual screening of their cardiovascular risk (CVR) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in cardiovascular risk management programmes in Dutch primary care is low.

The purpose was to explore the barriers and facilitators perceived by GPs to perform CVR screening in patients with SMI or receiving APs.

Methods

A qualitative interview study among Dutch GPs. Barriers and facilitators were explored by individual in-depth, semi-structured interviews using a computer-generated list of eligible patients with SMI or APs but without annual CVR screening. Data were analysed thematically.

Results

The main barriers were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through the use of a computer-generated list of eligible patients and (ii) involvement of family or carers.

Conclusions

This study indicates the preconditions required to facilitate GP inclusion of this specific population in primary care CVR management programmes, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence, and incentives for practices in deprived areas.