Cardiovascular risk management in patients using antipsychotics: a qualitative feasibility study

Patients on antipsychotic medication (APM) have an increased risk of cardiovascular disease (CVD). In general practice, however, there is a lack of solid cardiovascular risk (CVR) management for this specific group. TACTIC, a person-centred multidisciplinary cardiovascular risk programme, which aims to decrease cardiovascular risk and review APM use, was piloted in general practice.

To explore barriers and facilitators for delivering the TACTIC intervention, and assess which adjustments have to be made to evaluate its effectiveness and implementability in a future randomised controlled trial (RCT).

Qualitative analysis of the feasibility study in three Dutch general practices.

We performed eight individual interviews with patients and two focus group interviews with 11 healthcare professionals (HCPs) involved in the study. Interviews were semi-structured and topic guides were informed by the normalisation process theory (NPT). We used the framework method for analysis of our data.

The three main barriers for delivering TACTIC were as follows: the tension towards the intervention experienced by patients; the course of the multidisciplinary meeting (MDM); and the high workload experienced by GPs. The main facilitators were associated with the person-centred approach, the clear information meeting, and the ability of adjusting roles during the course of the intervention, including bringing a carer. Valuable suggestions for improvement were introducing a summary report from the psychiatrist, improving expectation management for patients, and adjusting the definition of the target group.

Several adjustments to the TACTIC intervention are necessary before evaluation in a larger RCT can take place. This work underlines the importance of performing a feasibility study before a trial to improve its effectiveness and efficacy.