Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed

To the Editor: The research letter by Hespe and colleagues1 on cardiovascular disease prevention is itself a missed opportunity to illuminate the complexities of person‐focused management of patients in general practice. While it provides a snapshot on cardiovascular disease prevention, it does not offer any exploration of the veracity or otherwise of these findings. Aggregate decontextualised and — as acknowledged — limited data ultimately fail to identify the true nature of the problem. Simply focusing on easily extractable data from computerised medical record systems, without linkage to the unique features and context of the person to whom these data belong, necessarily results in a distorted picture. Big data has the potential to inform only if it is appropriately interpreted and may be useful in process monitoring. Such data have a limited role in assessing general practitioner performance and outcomes of care.2

One must always remember that guidelines are nothing more than guides, which must be appropriately adapted to the unique circumstances of each patient. A more relevant research question would be: how appropriately or inappropriately are preventive treatments applied? This question addresses both overtreatment and undertreatment.3 As a binary question, however, it fails to ask more important contextual questions such as whether the patient can cope with the demands of the treatment, whether the treatment decision is a truly informed one, and whether it fits the needs and expectations of the patient given other health concerns. It ignores entirely the impact of a therapeutic alliance on actual health outcomes.4 Finally, the implied need for a hawkish attitude to prevention must take account of the fact that no intervention is risk‐free. Our obligation clearly states: primum non nocere.

Research aiming to improve understanding of the interdependencies inherent in each and every consultation is urgently needed. The health and wellbeing outcomes of medical care are far less determined by biomedical interventions than by the contextual stressors in a person’s life.5 Providing general practice with the tools and resources to truly address the complexities of our patients’ needs is of utmost urgency.