• Br J Gen Pract · Sep 2003

    Multicenter Study

    A qualitative study of barriers to the use of statins and the implementation of coronary heart disease prevention in primary care.

    • John Kedward and Lorraine Dakin.
    • The Health Centre, 84-86 London Road, Bedford, Bedfordshire MK42 0NT. john@jkedward.freeserve.co.uk
    • Br J Gen Pract. 2003 Sep 1; 53 (494): 684-9.

    BackgroundStatin prescribing to prevent coronary heart disease is well below recommended levels. Studies suggest that the prescribing behaviour of doctors may be the biggest factor in the wide variation in statin prescribing in general practice. Understanding doctors' perceptions offers some insight into why variation occurs.AimTo understand general practitioners' (GPs') views about barriers to statin prescribing, statin prescribing guidelines, and the successes and barriers to coronary prevention in primary care.Design Of StudyQualitative analysis of semi-structured interviews.SettingGeneral practices in mid and south Bedfordshire.MethodInterviews with 26 GPs.ResultsGPs spoke of a variety of barriers to initiating statin treatment specifically, and coronary heart disease prevention generally. Barriers to statin prescribing included: concerns about cost; increased workload and adherence to treatment; variation in treatment targets for lowering cholesterol; and concerns about medicalisation, lifestyle, and health behaviour. GPs found it difficult to prioritize patients for statin treatment, their statin treatment targets varied, and many found primary prevention risk assessment tools difficult to interpret. Coronary prevention was limited by practice space and organisational issues, by problems with recording and retrieval of electronic data, and by limited doctor and nurse time. GPs suggested that funded nurse time, nurse-led heart disease clinics, and better use of electronic data would improve primary care coronary prevention.ConclusionThere are complex barriers to statin prescribing and coronary prevention in general practice, which may explain some of the variation that exists. Further studies of patients' views of statins may provide more information. More resources, improved guidance, and better dissemination of guidance may only address some of the issues.

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