Barriers to prevention of cardiovascular disease in primary care settings in Argentina Obstáculos en la prevención de las enfermedades cardiovasculares en entornos de atención primaria en Argentina

• Main Authors: Daniel Ferrante, Jonatan Konfino, Bruno Linetzky, Ana Tambussi, Sebástian Laspiur
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2013
• Subjects: Enfermedades cardiovasculares; prevención primaria; prevención de enfermedades; Argentina; Cardiovascular diseases; primary prevention; disease prevention; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/d46ecb1feb104fe186ad1f75bab6af70

OBJECTIVE: To identify main barriers to preventing cardiovascular disease and implementing clinical practice guidelines in primary care, to pilot implementation of a tailored enactment of the adapted World Health Organization guidelines to prevent cardiovascular disease, and to assess the impact of the intervention in risk stratification. METHODS: A qualitative study was done with decision makers, health professionals, and staff from five primary health care centers, who were interviewed to identify the main barriers. A tailored intervention to apply the guidelines was then designed and implemented. To assess the impact of the intervention on risk factor screening, a before-and-after analysis was performed through a records review of independent samples of patients aged 40 years or older attending each center. RESULTS: The main barriers identified were lack of awareness of guidelines and lack of knowledge about preventing cardiovascular disease, communication problems within health teams, lack of motivation, and organizational problems. Before (n = 226) and after (n = 234) the intervention, screening of the main risk factors increased: blood pressure measurement from 44.3% to 72.6%, cholesterol measurement from 20.7% to 49.7%, smoking status assessment from 20.4% to 56.1%, diabetes status assessment from 25.5% to 93.6%, and previous vascular event status from 33.2% to 74.3%. Global risk stratification was not done at baseline, compared with 45.1% after the intervention. CONCLUSIONS: The main barriers identified were useful in designing a tailored intervention. Although no clinical outcomes were evaluated, this study shows that the implementation is feasible, with increased risk stratification as a first step at better patient management. OBJETIVO: Determinar las principales barreras en la prevención de las enfermedades cardiovasculares y la aplicación de las directrices de práctica clínica en atención primaria, guiar la adecuada puesta en práctica de las directrices adaptadas de la Organización Mundial de la ...