Barriers for general practitioners in post-stroke follow-up within a fragmented healthcare system in Sweden - a focus group study.

BACKGROUND

Secondary medical prevention after stroke is effective and well evidenced, making long-term follow-up crucial. This follow-up is mainly made by general practitioners (GPs) in Sweden. Low target achievement and up to fourfold practice variation in dispensation of secondary preventive drugs between different primary care units in Region Stockholm has been described. Although several factors in individual practices have been observed to be associated with insufficient target achievements, the underlying reasons for this variation are unclear.

OBJECTIVES

To explore the perspectives of GPs concerning secondary preventive practices after stroke to shed light on areas of improvement.

METHODS

This qualitative study was based on eight focus group discussions with 49 GPs in Region Stockholm. They were strategically invited in relation to target achievement, and the interviews (45-55 min) were conducted using a semi-structured interview guide. The interviews were transcribed and analysed using qualitative content analysis.

RESULTS

There were two themes: "Multifaceted mission in an insufficiently organized healthcare system" and "The complexity of adherence". There were six categories that encompassed shortcomings in the areas of: sufficient time for the patients, the overarching structure of the healthcare system, the internal structure of follow-ups, medical adherence, the responsibility for renewals of medication and tools for adherence.

CONCLUSION

The perspectives of GPs revealed structural problems at different levels in the health care system as well as difficulties in handling medication adherence indicating a need for improvement. GPs touched on solutions including increasing the number of GPs, education and improved referrals from hospital to primary care.