Barriers to The Utilization of Cardiovascular Risk Prediction Tools as Perceived by Primary Health Care and Family Physicians

Background: Mortality from cardiovascular diseases was ranked the first cause of death in Egypt, accounting for 46% of total deaths. Although the use of cardiovascular risk prediction tools (CVRPT) to identify those at higher risk was proven to be a cost-effective strategy, these tools remain underutilized in clinical practice. Objective: To investigate the barriers to the utilization of CVRPT as perceived by primary health care and family physicians. Subjects and Methods: A cross sectional study was conducted in 25 primary health care and family medicine units in three Egyptian cities using an adapted questionnaire. Results: One hundred and seventy six (176) eligible physicians from a recruited sample of 230 (response rate=76%) participated in the study. About 81% of all physicians rarely or never use CVRPT. Most often stated barriers to use CVRPT are: distrust in stakeholders’ interest (88.7%), patients’ non-compliance due to inability to afford requested investigations (83%), and the imperfection of using single score in measuring patient’s global cardiovascular risk (82%). Among different questionnaire domains, the “distrust in CVRPT validity” was found to be the most important domain influencing the utilization of CVRPT (p=0.045), and among all questionnaire items, the “Distrust in stakeholders’ interest”, and “a single score doesn’t take into account the complex situation of the patient” were found to be the most important indicators influencing CVRPT utilization by logistic regression analysis. Forty seven percent (47%) reported that the health care system does not support the use of CVRPT due to economic reasons, and 36% reported the need for an easy and cost-effective tool. Conclusion: Distrust in the validity and comprehensiveness of CVRPT, distrust in stakeholders, lack of time, lack of physician knowledge and training, and economic reasons were the most important barriers against the utilization of CVRPT. Further studies are needed for examining the effect of global CVD calculation on actual patient outcomes. Communication among CVRPT stakeholders and health care policy makers in Egypt, adopting a simple, cost effective CVRPT, and physician training were suggested to promote the utilization of CVR scores in clinical practice.