Patients' and practice nurses' perceptions of secondary preventive care for established ischaemic heart disease: a qualitative study

A significant proportion of patients with established ischaemic heart disea se remain unrecognized in general practice and those who are receiving trea tment are experiencing sub-optimal care. The provision of coronary prevention by practice nurses may be an important strategy to improve the quality of this care, and this is feasible and eff ective. This study explored what occurred during patients' initial assessment for s econdary prevention of ischaemic heart disease with a practice nurse and in vestigated patients' and practice nurses' views of nurse-led clinics in pri mary care. Nurses were effective in history taking and offering reassurance and dietar y advice, yet were less confident in discussing patients' understandings of heart disease and related medication. Practice nurse-led coronary preventive care is acceptable to both nurses an d patients. Further practice nurse education is required in heart disease, cardiac medi cations and skills necessary for exploring and challenging patients' unders tandings of these issues.