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 |