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

Background: Patients on antipsychotic medication (APM) have an increased risk of cardiovascular disease (CVD). In general practice, however, there is a lack of solid cardiovascular risk (CVR) management for this specific group. TACTIC, a person-centred multidisciplinary cardiovascular risk programme, which aims to decrease cardiovascular risk and review APM 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 randomised controlled trial (RCT). Design & setting: Qualitative analysis of the feasibility study in three Dutch general practices. Method: We performed eight individual interviews with patients and two focus group interviews with 11 healthcare professionals (HCPs) involved in the study. Interviews were semi-structured and topic guides were informed by the normalisation process theory (NPT). We used the framework method for analysis of our data. Results: The three main barriers for delivering TACTIC were as follows: the tension towards the intervention experienced by patients; the course of the multidisciplinary meeting (MDM); and the high workload experienced by GPs. The main facilitators were associated with the person-centred approach, the clear information meeting, and the ability of adjusting roles during the course of the intervention, including bringing a carer. 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 RCT can take place. This work underlines the importance of performing a feasibility study before a trial to improve its effectiveness and efficacy.