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Factors influencing the implementation of cardiovascular risk scoring in primary care: a mixed-method systematic
Tonny B Muthee1, Derick Kimathi2, Georgia C Richards3
1Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK. tonny.muthee@phc.ox.ac.uk.
Insights
Implementing cardiovascular risk scoring tools is crucial for managing cardiovascular diseases (CVD). Factors influencing their adoption in primary care involve healthcare systems, users, and tool characteristics, with limited research in low-income countries.
Area of Science:
- Public Health
- Health Services Research
- Cardiology
Background:
- Cardiovascular diseases (CVD) are a leading global cause of death and disability, with a growing impact in low and middle-income countries.
- Reducing CVD risk factors is key to managing disease incidence and prevalence.
- Cardiovascular risk stratification tools aid clinical decision-making but face implementation challenges.
Purpose of the Study:
- To systematically review and synthesize current knowledge on factors influencing the implementation of cardiovascular risk scoring tools in primary care settings.
- To identify barriers and facilitators to the adoption of these tools in clinical practice.
Main Methods:
- A systematic review of bibliographic databases and grey literature was conducted.
- Studies of any design were assessed for eligibility, quality, and data extraction.
- A mixed-methods synthesis approach, guided by the Consolidated Framework for Implementation Research, was used.
Main Results:
- Twenty-five studies were included, predominantly from high-income countries, with limited patient participation.
- Eleven cardiovascular risk stratification tools were analyzed.
- Key influencing factors include clinical setting/healthcare system characteristics, user attributes and interactions, and the specific tool's features and perceived effectiveness.
Conclusions:
- Implementation of cardiovascular risk scoring is complex, influenced by multiple factors.
- There is a significant gap in research from low and middle-income countries.
- Future efforts should address this gap and provide evidence on the clinical effectiveness of risk scoring for improving CVD outcomes.
Background:
Cardiovascular disease (CVD) such as ischemic heart disease and stroke is the leading causes of death and disability globally with a growing burden in low and middle-income countries. A credible way of managing the incidence and prevalence of cardiovascular diseases is by reducing risk factors. This understanding has led to the development and recommendation for the clinical use of cardiovascular risk stratification tools. These tools enhance clinical decision-making. However, there is a lag in the implementation of these tools in most countries. This systematic review seeks to synthesise the current knowledge of the factors influencing the implementation of cardiovascular risk scoring in primary care settings.
Methods:
We searched bibliographic databases and grey literature for studies of any design relating to the topic. Titles, abstracts and full texts were independently assessed for eligibility by two reviewers. This was followed by quality assessment and data extraction. We analysed data using an integrated and best fit framework synthesis approach to identify these factors. Quantitative and qualitative forms of data were combined into a single mixed-methods synthesis. The Consolidated Framework for Implementation Research was used as the guiding tool and template for this analysis.
Results:
Twenty-five studies (cross-sectional n = 12, qualitative n = 9 and mixed-methods n = 4) were included in this review. Twenty (80%) of these were conducted in high-income countries. Only four studies (16%) included patients as participants. This review reports on a total of eleven cardiovascular risk stratification tools. The factors influencing the implementation of cardiovascular risk scoring are related to clinical setting and healthcare system (resources, priorities, practice culture and organisation), users (attributes and interactions between users) and the specific cardiovascular risk tool (characteristics, perceived role and effectiveness).
Conclusions:
While these findings bolster the understanding of implementation complexity, there exists limited research in the context of low and middle-income countries. Notwithstanding the need to direct resources in bridging this gap, it is also crucial that these efforts are in concert with providing high-quality evidence on the clinical effectiveness of using cardiovascular risk scoring to improve cardiovascular disease outcomes of mortality and morbidity.
Trial Registration:
PROSPERO registration number: CRD42018092679.
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