Running nurse-led secondary prevention clinics for coronary heart disease in primary care: qualitative study of health professionals' perspectives

P Murchie, N C Campbell, L D Ritchie, J Thain

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background A randomised trial of nurse-led secondary prevention clinics for coronary heart disease resulted in improved secondary prevention and significantly lowered all-cause mortality at 4-year follow-up. This qualitative trial was conducted to explore the experience of health professionals that had been involved in running the clinics.

Aim To identify the barriers and facilitators to establishing secondary prevention clinics for coronary heart disease within primary care.

Design of study Semi-structured audiotaped telephone interviews with GPs and nurses involved in running clinics.

Setting A stratified, random sample of 19 urban, suburban, and rural general practices in north-east Scotland.

Method Semi-structured telephone interviews with 19 GPs and 17 practice-based nurses involved in running nurse-led clinics for the secondary prevention of coronary heart disease.

Results Eight practices had run clinics continuously and 11 had stopped, with eight subsequently restarting. Participants accounted for these patterns by referring to advantages and disadvantages of the clinics in four areas: patient care, development of nursing skills, team working, and infrastructure. Most practitioners perceived benefits for patients from attending secondary prevention clinics, but some, from small rural practices, thought they were unnecessary. The extended role for nurses was welcomed, but was dependent on motivated staff, appropriate training and support. Clinics relied on, and could enhance, team working, however, some doctors were wary of delegating. With regard to infrastructure, staff shortages (especially nurses) and accommodation were as problematic as lack of funds.

Conclusions Nurse-led secondary prevention clinics were viewed positively by most healthcare professionals that had been involved in running them, but barriers to their implementation had led most to stop running them at some point. Lack of space and staff shortages are likely to remain ongoing problems, but improvements in funding training and communication within practices could help clinics to be put into practice and sustained.

Original languageEnglish
Pages (from-to)522-528
Number of pages7
JournalThe British Journal of General Practice
Volume55
Publication statusPublished - 2005

Keywords

  • coronary heart disease
  • primary care
  • secondary prevention
  • RANDOMIZED CONTROLLED TRIAL
  • SERVICES RESEARCH
  • COMPLEX

Cite this

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title = "Running nurse-led secondary prevention clinics for coronary heart disease in primary care: qualitative study of health professionals' perspectives",
abstract = "Background A randomised trial of nurse-led secondary prevention clinics for coronary heart disease resulted in improved secondary prevention and significantly lowered all-cause mortality at 4-year follow-up. This qualitative trial was conducted to explore the experience of health professionals that had been involved in running the clinics.Aim To identify the barriers and facilitators to establishing secondary prevention clinics for coronary heart disease within primary care.Design of study Semi-structured audiotaped telephone interviews with GPs and nurses involved in running clinics.Setting A stratified, random sample of 19 urban, suburban, and rural general practices in north-east Scotland.Method Semi-structured telephone interviews with 19 GPs and 17 practice-based nurses involved in running nurse-led clinics for the secondary prevention of coronary heart disease.Results Eight practices had run clinics continuously and 11 had stopped, with eight subsequently restarting. Participants accounted for these patterns by referring to advantages and disadvantages of the clinics in four areas: patient care, development of nursing skills, team working, and infrastructure. Most practitioners perceived benefits for patients from attending secondary prevention clinics, but some, from small rural practices, thought they were unnecessary. The extended role for nurses was welcomed, but was dependent on motivated staff, appropriate training and support. Clinics relied on, and could enhance, team working, however, some doctors were wary of delegating. With regard to infrastructure, staff shortages (especially nurses) and accommodation were as problematic as lack of funds.Conclusions Nurse-led secondary prevention clinics were viewed positively by most healthcare professionals that had been involved in running them, but barriers to their implementation had led most to stop running them at some point. Lack of space and staff shortages are likely to remain ongoing problems, but improvements in funding training and communication within practices could help clinics to be put into practice and sustained.",
keywords = "coronary heart disease, primary care, secondary prevention, RANDOMIZED CONTROLLED TRIAL, SERVICES RESEARCH, COMPLEX",
author = "P Murchie and Campbell, {N C} and Ritchie, {L D} and J Thain",
year = "2005",
language = "English",
volume = "55",
pages = "522--528",
journal = "The British Journal of General Practice",
issn = "0960-1643",
publisher = "Royal College of General Practitioners",

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T1 - Running nurse-led secondary prevention clinics for coronary heart disease in primary care: qualitative study of health professionals' perspectives

AU - Murchie, P

AU - Campbell, N C

AU - Ritchie, L D

AU - Thain, J

PY - 2005

Y1 - 2005

N2 - Background A randomised trial of nurse-led secondary prevention clinics for coronary heart disease resulted in improved secondary prevention and significantly lowered all-cause mortality at 4-year follow-up. This qualitative trial was conducted to explore the experience of health professionals that had been involved in running the clinics.Aim To identify the barriers and facilitators to establishing secondary prevention clinics for coronary heart disease within primary care.Design of study Semi-structured audiotaped telephone interviews with GPs and nurses involved in running clinics.Setting A stratified, random sample of 19 urban, suburban, and rural general practices in north-east Scotland.Method Semi-structured telephone interviews with 19 GPs and 17 practice-based nurses involved in running nurse-led clinics for the secondary prevention of coronary heart disease.Results Eight practices had run clinics continuously and 11 had stopped, with eight subsequently restarting. Participants accounted for these patterns by referring to advantages and disadvantages of the clinics in four areas: patient care, development of nursing skills, team working, and infrastructure. Most practitioners perceived benefits for patients from attending secondary prevention clinics, but some, from small rural practices, thought they were unnecessary. The extended role for nurses was welcomed, but was dependent on motivated staff, appropriate training and support. Clinics relied on, and could enhance, team working, however, some doctors were wary of delegating. With regard to infrastructure, staff shortages (especially nurses) and accommodation were as problematic as lack of funds.Conclusions Nurse-led secondary prevention clinics were viewed positively by most healthcare professionals that had been involved in running them, but barriers to their implementation had led most to stop running them at some point. Lack of space and staff shortages are likely to remain ongoing problems, but improvements in funding training and communication within practices could help clinics to be put into practice and sustained.

AB - Background A randomised trial of nurse-led secondary prevention clinics for coronary heart disease resulted in improved secondary prevention and significantly lowered all-cause mortality at 4-year follow-up. This qualitative trial was conducted to explore the experience of health professionals that had been involved in running the clinics.Aim To identify the barriers and facilitators to establishing secondary prevention clinics for coronary heart disease within primary care.Design of study Semi-structured audiotaped telephone interviews with GPs and nurses involved in running clinics.Setting A stratified, random sample of 19 urban, suburban, and rural general practices in north-east Scotland.Method Semi-structured telephone interviews with 19 GPs and 17 practice-based nurses involved in running nurse-led clinics for the secondary prevention of coronary heart disease.Results Eight practices had run clinics continuously and 11 had stopped, with eight subsequently restarting. Participants accounted for these patterns by referring to advantages and disadvantages of the clinics in four areas: patient care, development of nursing skills, team working, and infrastructure. Most practitioners perceived benefits for patients from attending secondary prevention clinics, but some, from small rural practices, thought they were unnecessary. The extended role for nurses was welcomed, but was dependent on motivated staff, appropriate training and support. Clinics relied on, and could enhance, team working, however, some doctors were wary of delegating. With regard to infrastructure, staff shortages (especially nurses) and accommodation were as problematic as lack of funds.Conclusions Nurse-led secondary prevention clinics were viewed positively by most healthcare professionals that had been involved in running them, but barriers to their implementation had led most to stop running them at some point. Lack of space and staff shortages are likely to remain ongoing problems, but improvements in funding training and communication within practices could help clinics to be put into practice and sustained.

KW - coronary heart disease

KW - primary care

KW - secondary prevention

KW - RANDOMIZED CONTROLLED TRIAL

KW - SERVICES RESEARCH

KW - COMPLEX

M3 - Article

VL - 55

SP - 522

EP - 528

JO - The British Journal of General Practice

JF - The British Journal of General Practice

SN - 0960-1643

ER -