Cardiovascular risk management in patients using antipsychotics - a qualitative feasibility study.

Background: Patients on antipsychotic medication have an increased risk of cardiovascular disease. In general practice however, there is a lack of solid cardiovascular risk management for this specific group. TACTIC, a person-centred multidisciplinary cardiovascular risk program aimed to decrease cardiovascular risk and review antipsychotic medication use, was piloted in general practice.

Aim: To explore barriers and facilitators for delivering the TACTIC intervention, and assess which adjustments have to be made to evaluate its effectiveness and implementability in a future RCT.

Design & setting: Qualitative analysis of the feasibility study in three Dutch general practices.

Method: We performed 8 individual interviews with patients and 2 focus group interviews with 11 healthcare professionals involved in the study. Interviews were semi-structured and topic guides were informed by the Normalization Process Theory. We used the Framework Method for analysis of our data.

Results: Barriers were associated with experienced tension by patients due to participation, the course of the multidisciplinary meeting, and the high workload experienced by general practitioners. Facilitators were associated with the person-centred approach, the clear information meeting and the ability of adjusting roles in the intervention. Valuable suggestions for improvement were introducing a summary report from the psychiatrist, improving expectation management for patients and adjusting the definition of the target group.

Conclusion: Several adjustments to the TACTIC intervention are necessary before evaluation in a larger randomised controlled trial can take place. This work underlines the importance of performing a feasibility study prior to a trial to improve its effectiveness and efficacy.