Barriers to and Facilitators of Implementing Guidelines for Detecting Familial Hypercholesterolaemia in Australia
Mitchell Sarkies, Luke Testa, Stephanie Best, Joanna C. Moullin, David Sullivan, Warrick Bishop, Karam Kostner, Peter Clifton, David L. Hare, Tom Brett, Karen Hutchinson, Andrew Black, Jeffrey Braithwaite, Stephen J. Nicholls, Nadarajah Kangaharan, Jing Pang, Walter P. Abhayaratna, Ari Horton, Gerald F. Watts
Abstract
BackgroundFamilial hypercholesterolaemia (FH) is a genetic condition that is a preventable cause of premature cardiovascular morbidity and mortality. High-level evidence and clinical practice guidelines support preventative care for people with FH. However, it is estimated that less than 10% of people at risk of FH have been detected using any approach across Australian health settings. The aim of this study was to identify the implementation barriers to and facilitators of the detection of FH in Australia.MethodsFour, 2-hour virtual focus groups were facilitated by implementation scientists and a clinicians as part of the 2021 Australasian FH Summit. Template analysis was used to identify themes.ResultsThere were 28 workshop attendees across four groups (n=6–8 each), yielding 13 barriers and 10 facilitators across three themes: (1) patient related, (2) provider related, and (3) system related. A “lack of care pathways” and “upskilling clinicians in identifying and diagnosing FH” were the most interconnected barriers and facilitators for the detection of FH.ConclusionsThe relationships between barriers and facilitators across the patient, provider, and system themes indicates that a comprehensive implementation strategy is needed to address these different levels. Future research is underway to develop a model for implementing the Australian FH guidelines into practice. Familial hypercholesterolaemia (FH) is a genetic condition that is a preventable cause of premature cardiovascular morbidity and mortality. High-level evidence and clinical practice guidelines support preventative care for people with FH. However, it is estimated that less than 10% of people at risk of FH have been detected using any approach across Australian health settings. The aim of this study was to identify the implementation barriers to and facilitators of the detection of FH in Australia. Four, 2-hour virtual focus groups were facilitated by implementation scientists and a clinicians as part of the 2021 Australasian FH Summit. Template analysis was used to identify themes. There were 28 workshop attendees across four groups (n=6–8 each), yielding 13 barriers and 10 facilitators across three themes: (1) patient related, (2) provider related, and (3) system related. A “lack of care pathways” and “upskilling clinicians in identifying and diagnosing FH” were the most interconnected barriers and facilitators for the detection of FH. The relationships between barriers and facilitators across the patient, provider, and system themes indicates that a comprehensive implementation strategy is needed to address these different levels. Future research is underway to develop a model for implementing the Australian FH guidelines into practice.