This study involved one-to-one, semi-structured interviews of GPs working in Oxfordshire, UK. Postal invitations were initially sent out to 222 practitioners from a list compiled from the Thames Valley Primary Care Agency and practice websites; those who volunteered to be interviewed were also asked to suggest potentially interested colleagues to whom a further invitation was sent by e-mail. Recruitment continued until data saturation, a theoretical point achieved when no additional data is being found,8 which was achieved after 20 interviews. Participants were aged 32–61 years; four were female. Most participants were profit-sharing partners in the practice, three were salaried partners and one was a registrar. All participants used on-desk computers for record keeping in the consultation and so had access to electronic versions of the risk scores.
How this fits in
All GPs in the UK are now required to use cardiovascular risk scores in their clinical practice but informal discussion suggested variability in how they are interpreted and used. Only one previous qualitative study outside the UK has explored this issue and the findings suggest considerable confusion in understanding and variability in practice. National guidance does not appear to be fit for purpose as it has become increasingly complex while failing to reflect how practitioners are actually using the scores and the advice that they need. Patients would be better served by simple advice to practitioners to use a Framingham score and exercise more clinical judgement, explaining to patients the necessary imprecision of any individual estimate of risk.
Data analysis
The transcripts were checked for accuracy. After repeated reading of the transcripts, the text was coded independently under different headings by two coders, using a thematic approach to analysis. The few discrepancies in coding were resolved by discussion. Once coding was finished, a written and graphical summary of the issues was created for each code using the OSOP (one sheet of paper) method9 where every section of data relevant to that code from all the different interviews is noted. Analysis was performed by two researchers, one clinical (the non-UK GP) and one non-clinical. The software package NVivo9 facilitated the analysis of themes and systematic comparison across transcripts. Given the volume of data and the main objective of this study, detailed analysis focused on the use of cardiovascular risk scores to inform treatment decisions.
