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背景虽然相关指南提出心血管疾病二级预防不受年龄影响,但是年长患者接受的相关治疗少于年轻患者。目标探讨荷兰全科医生在年长患者心血管疾病二级预防指南执行中面临的困境。设计和场所组织4个焦点小组进行讨论,对结果进行定性研究,焦点小组由23名来自南荷兰省北部的全科医生和4名来自荷兰莱顿大学医学中心的全科实习医生组成。方法通过焦点小组,搜集关于年长患者心血管疾病二级预防的实施观点。根据精炼理论领域框架(TDF)的14个理论领域,对焦点小组讨论内容进行(演绎)编码。分析编码文本,讨论其内容,识别每一个TDF领域的障碍和促进因素。结果主题为“不确定性”。障碍与指南、患者、组织相关。促进与医生、患者、组织相关。二级预防治疗的主要目的是提高生活质量。结论荷兰全科医生对心血管疾病二级治疗的各方面均有不确定性,包括指南本身、自身的作用、患者因素和照护组织。鉴于这些不确定性,全科医生通过与患者单独进行密切谈话,有意识地对各方面进行权衡,最终目标均是提高生活质量。而高度个性化治疗正是处方率下降的主要原因。
Background Although the guidelines suggest that secondary prevention of cardiovascular disease is not affected by age, older patients receive fewer treatments than younger patients. Objectives Explore the dilemmas faced by Dutch GPs in the implementation of secondary prevention guidelines for cardiovascular disease in older patients. Design and organization of four focus groups to discuss and conduct a qualitative study of the results. The focus group consists of 23 general practitioners from the northern province of South Holland and four general practitioners from the Leiden University Medical Center in Netherlands. Methods Focus groups were used to collect opinions on the implementation of secondary prevention of cardiovascular disease in elderly patients. According to the 14 Theoretical Areas of the Framework of Refined Theory (TDF), the focus group discussions are coded (deductively). Analyze the coding text, discuss its contents, and identify the barriers and facilitators in each TDF area. The subject of the result is “Uncertainty ”. Barriers are related to guidelines, patients, and tissues. Promote and doctors, patients, organizations related. The main purpose of secondary prevention and treatment is to improve the quality of life. Conclusion Dutch GPs are uncertain about all aspects of secondary treatment of cardiovascular disease, including the guideline itself, its role, patient factors, and care organization. Given these uncertainties, GPs consciously weigh the various aspects through close conversations with patients alone, with the ultimate goal of improving the quality of life. The high degree of personalized treatment is the main reason for the decline in the prescription rate.