چکیده (انگلیسی):

Background:Although conditions for high quality cardiovascular risk management in primary care in the Netherlands
are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of
the current study was to identify determinants of cardiovascular primary care in the Netherlands.
Methods:We performed a qualitative study, using semi-structured interviews with healthcare professionals and
patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to
cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3)
patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability,
and 7) social, political and legal factors.
Results:Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients
mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health
care professionals were related to communication between healthcare professionals, patients’ lack of knowledge
and self-management, time management, market mechanisms in the Dutch healthcare system and motivational
interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk
factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is
the mismatch between healthcare professionals’ and patients’ views on patient’s knowledge and self-management.
Conclusions:Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and
(but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon
the importance of patients’ knowledge and self-management, their judgment of the current state of knowledge and
self-management is entirely different.