• Ann-Helen Patomella, Gustav Mickols, Eric Asaba, Gunnar Nilsson, Cecilia Fridén, Anders Kottorp, Bo Christer Bertilson, and Kerstin Tham.
• Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, 141 83, Stockholm, Sweden. ann-helen.patomella@ki.se.
• Bmc Fam Pract. 2018 Dec 4; 19 (1): 190190.

BackgroundBy screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs' reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care.MethodsA qualitative design based in a grounded theory approach was chosen in order to investigate this unexplored research area. Data collection was done using focus group interviews and data was analysed using a constant comparative method. Twenty-two GPs were interviewed in four focus groups.ResultsFindings showed that GPs perceived difficulties in prioritizing patients with an unhealthy lifestyle and described a lack of systematicity in their procedures, which complicated their clinical decisions concerning patients with stroke risk factors. The results showed a lack of systematic risk screening methods. Time constraints and the reimbursement system were described as hindering the preventive work.ConclusionThere is a need for a more proactive, transparent and systematic approach in the distribution of GPs' time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved.

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