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Table 2 Thematic matrix

From: General practitioners’ perceptions about their role in current and future heart failure care: an exploratory qualitative study

Theme 1: GPs’ perceptions about their current role in HF care
  HF-specific factors Patient factors Physician factors Contextual factors
Prohibiting factors
General HF care • HF is perceived as labour-intensive • Difficulties associated with comorbidities, age and polypharmacy • Lack of experience
• Lack of confidence
• Lack of time
• Administrative burden
Diagnosis • Non-discriminating symptoms and signs in chronic HF • Reluctance in diagnosis of older patients • Lack of awareness for HF • Lack of availability of diagnostic tests in primary care
Treatment   • Difficulties associated with comorbidities and polypharmacy
• Limited compliance with taking diuretics
• Reluctance to treat older patients
• Lack of up-to-date knowledge
• Lack of experience
 
Education   • Lack of patient compliance with dietary restrictions • Lack of motivational interviewing skills • Lack of time/HF education is experienced as time-consuming
Theme 2: Roles of GP within a multidisciplinary team
Collaboration with cardiologists
Prohibiting factors    • Resistance to work with cardiologists that do not share patients or who do not communicate
• Specialist care leads to fragmented care
• Transition of care after discharge from hospital should be improved
• Lack of two-way communication about patients
Facilitating factors    • Preference for cardiologists that share care, are easily accessible, and give advice for follow-up in discharge letters
• Informal contact with specialists outside of practice eases collaboration
• Easy access to cardiologists
- Telephone advice to GPs
- Short waiting lists for patients
• Fast and qualitative feedback by letter after cardiologist consultation
Collaboration with nurses
Prohibiting factors    • Lack of trust in the nurse competencies
• Nurses lack knowledge about HF alarm symptoms
• Difficult communication about patients
• Lack of role clarity in telemonitoring projects
Facilitators    • Positive previous experiences  
Future organization of multidisciplinary HF care
Care pathway for HF   • Needs to be flexible/patient-centred • Meets the need for support in staying up-to-date/doing the right thing
• Fear of being overlooked
• Fear of fragmentation of care
• Central role for GP
• No additional administration
• Structured guidance, not obligatory
Collaboration with specialized HF nurses    • Fear of being overlooked
• Fear of fragmentation of care
• Lack of knowledge about HF nurses
• Preference for all-round general practice nurse
• Need for financial support
• Need for support in education of general practice nurses