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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