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Background Although recommended in clinical practice guidelines, cardiovascular absolute risk (CVAR) assessment is still used infrequently in Australian general practice. One reason is the lack of an implementation strategy. Given the lack of published reports on the implementation of CVAR worldwide, the aim of this study was to explore the views of general practitioners (GPs) and patients on prerequisites for successfully implementing CVAR assessment in general practice. Methods Multiple data involving GPs and patients were collected using focus groups (FGs) in three divisions of General Practice in Sydney between 2005 and 2006. Both GPs' and patients' opinions were analysed using thematic analysis. Results Twenty-two GPs participated in three GP FGs and 26 patients in three patient FGs. Many GPs thought that an initial cardiovascular risk screening could start from 40 years old while some patients thought it should start even younger. Targeting patients with known risk factors was supported by most GPs although some also stressed the importance of reaching those of unknown risk. For new patients or patients presenting for other problems, another visit for CVAR risk assessment and discussion was preferred by most GPs. A strong GP–patient relationship, common ground on priorities between GPs and their patients, patient awareness of cardiovascular risk and motivation were seen as important by both GPs and patients to the implementation of CVAR assessment. Conclusions Addressing the appropriate selection of patients and time for implementing CVAR assessment requires a consideration of multiple factors. GPs see it as a process that may need to be staged over more than one consultation and requiring appropriate strategies. [ABSTRACT FROM AUTHOR]

Despite a decline in recent decades, cardiovascular disease (CVD) remains the major cause of death and disability in Australia. To improve primary prevention of CVD, many clinical guidelines recommend using cardiovascular absolute risk (CVAR) assessment to guide risk factor management. Cardiovascular absolute risk assessment predicts the overall risk of a cardiovascular event over a given time period (usually 5 or 10 years). However, use of CVAR is limited and has not been incorporated well in routine general practice. There has been little research on CVAR implementation and an effective implementation strategy has been lacking.

Background: The Health Improvement and Prevention Study (HIPS) study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization., Methods/design: HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs) and practice nurses (PNs) are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange) and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1) a practice questionnaire, (2) GP and PN questionnaires to assess preventive care attitudes and practices, (3) patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4) physical assessment including weight, height, body mass index (BMI), waist circumference and blood pressure, (5) a fasting blood test for glucose and lipids, (6) a clinical record audit, and (7) qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the intervention is compared between intervention and control groups after adjusting for baseline differences and clustering at the level of the practice., Discussion: This study will provide evidence of the effectiveness of a primary care intervention to reduce the risk of cardiovascular disease and diabetes in general practice patients. It will inform current policies and programs designed to prevent these conditions in Australian primary health care., Trial Registration: ACTRN12607000423415.