Introduction
Cardiovascular disease risk calculators can inform and guide preventive strategies
and treatment decisions by clinicians and patients. However, their uptake in primary
care has been slow despite the recommendation in national cardiovascular disease prevention
guidelines. Identifying the barriers to the implementation of cardiovascular disease
risk calculators is essential for promoting their adoption.
Methods
The authors qualitatively analyzed structured physician educator notes written during
an outreach education intervention with 44 small- and medium-sized primary care clinics
that participated in the Agency for Healthcare Research and Quality‒funded EvidenceNOW
Healthy Hearts Northwest trial. The authors coded barriers to the implementation of
cardiovascular disease risk calculation and aligned them to the Consolidated Framework
for Implementation Research.
Results
The authors identified 13 barriers from the physician educators’ notes. The majority
(n=8, 62%) mapped to the framework's Inner Setting domain. The 5 most commonly noted
barriers were (1) time constraints to use a calculator (N=23 clinics), (2) limitations
to accessing a calculator or the necessary information to use a calculator (N=22 clinics),
(3) no or minimal buy-in from clinicians or staff to use a calculator (N=19 clinics),
(4) reported patient fear of side effects from statin medications or patient dislike
of taking medications per the guidelines (N=17 clinics), and (5) lack of documented
clinic workflow for using a calculator (N=16 clinics).
Conclusions
To improve the uptake of cardiovascular disease risk calculation in primary care,
future cardiovascular disease prevention and implementation research should consider
tailoring interventions to the common barriers to implementing cardiovascular disease
risk calculation.
Trial registration
This study is registered at www.clinicaltrials.gov NCT02839382.
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Article Info
Publication History
Published online: December 03, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
