Bridging the gap between public health and primary care in prevention of cardiometabolic diseases; background of and experiences with the Prevention Consultation in The Netherlands.

BACKGROUND: There is an increasing need for programmatic prevention of cardiometabolic diseases (cardiovascular disease, type 2 diabetes and chronic kidney disease). Therefore, in the Netherlands, a prevention programme linked to primary care has been developed. This initiative was supported by the national professional organizations of GPs and occupational physicians as well as three large health foundations. OBJECTIVES: To describe and discuss the content, structure of and first experiences with this initiative. METHODS: Description of context, risk assessment tool, guideline, content of the Prevention Consultation and pilot studies. RESULTS: Preceding surveys revealed a need for proactive disease prevention, linked to primary care. An evidence-based guideline was developed using a validated eight-question screening list. According to the guideline, high-risk participants were advised to attend two consultations at the general practice, for completing the risk assessment and for tailored advice. Three pilot studies revealed that the programme was feasible and that (sufficient) participants with a condition requiring treatment were detected. We learned that with a 'passive' recruitment (with only posters and brochures), screening uptake is limited. A more active approach with a personal invitation from the GP is more effective. Both an Internet as written questionnaire should be available and reminders are necessary. The need for a consultation with the GP practice after a high-risk test result should be emphasized. The first consultation can be performed by a practice nurse. CONCLUSIONS: A national systematic screening programme for cardiometabolic diseases linked to primary care is feasible. The cost-effectiveness still has to be established.

Attitudes toward preventive services and lifestyle: the views of primary care patients in Europe. the EUROPREVIEW patient study.

BACKGROUND: For preventive interventions in general practice to succeed, patients' points of view must be taken into account in addition to those of GPs. OBJECTIVE: To explore patients' views and beliefs about the importance of lifestyle and preventive interventions, to assess their readiness to make changes to their lifestyle and their willingness to receive support from GPs. METHODS: Cross-sectional survey conducted by EUROPREV in primary care practices in 22 European countries. Patients were consecutively selected and interviewed from September 2008 to September 2009. RESULTS: Seven thousand nine hundred and forty-seven participants, 52.2% females. Only 30.5% of risky drinkers think they need to change, as opposed to 64% of smokers, 73.5% of patients with unhealthy eating habits and 73% with lack of physical activity. Risky drinkers reported that GPs initiated a discussion on alcohol consumption less often (42%) than on smoking (63%), eating habits (59%) or physical activity (55%). Seventy-five per cent, 66% and 63% of patients without hypertension, diabetes or hypercholesterolaemia, respectively, think blood pressure, blood sugar and serum cholesterol should be checked yearly. Women (80%) think they should be screened with the cervical smear test and 72.8% of women aged 30-49 years with mammography, yearly or every 2 years. CONCLUSIONS: A high proportion of patients attending primary care with unhealthy lifestyles (especially risky drinkers) do not perceive the need to change their habits, and about half the patients reported not having had any discussion on healthy lifestyles with their GPs. Patients overestimate their need to be screened for cardiovascular risk factors and for cancer.

Beliefs and attitudes to lifestyle, nutrition and physical activity: the views of patients in Europe.

OBJECTIVE: The aim of the EUROPREVIEW study was to explore patients' beliefs about the importance of lifestyle and preventive services, to assess their readiness to make changes in diet and physical activity and their willingness to receive support from GPs. METHODS: The study was done in 22 European countries, in 10 practices per country, with each 40 patients aged 30-70 years. The interview period was September 2008 to September 2009. The analysis was based on 7947 participants (52.2% females and 47.8% males). RESULTS: More than half of the patients think their lifestyle is important for their health: eating habits 53%, physical activity 55% and normal body weight 59%. Almost half of the patients think they have to improve their lifestyle in terms of eating behaviour (43%), physical activity (48%) and body weight (48%). More than half of the patients say they have plans to change and two-thirds say they are confident to succeed. Two-thirds of the patients say that they would like to receive support by their GP. About half of patients reported that GPs initiated a discussion about these topics. CONCLUSIONS: This study raises a number of health promotion and prevention issues of interest for primary health care providers. There is a discrepancy between the expectations of patients and the performance of GPs. A high proportion of patients who visited primary care with unhealthy lifestyles do not perceive the need to change and about half of the patients reported not having any discussion on these topics with GPs or primary care team.

Multifaceted support to improve preventive cardiovascular care: a nationwide, controlled trial in general practice.

BACKGROUND: Multifaceted interventions improve the quality of preventive cardiovascular care in general practice when applied in small-scale research trials. AIM: To test the transferability of observations from research trials on preventive cardiovascular care to a real-world situation and, therefore, evaluate the effectiveness of a nationwide project with a large number of practices. The intervention comprised a combination of conferences, dissemination of manuals, and support from trained non-physicians during outreach visits. DESIGN OF STUDY: A controlled before-and-after trial with two arms: multifaceted support versus no special attention. Analysis after 2 years. SETTING: 617 general practices in The Netherlands. METHOD: Outcomes measures were the compliance rates for 15 indicators. Structure-of-care indicators included the use of reminders, specific computer files, written protocols, and special clinics. Process-of-care indicators included the assessment of modifiable risk factors and use of a minimal contact intervention (MCI) for smoking cessation. Compliance of general practitioners (GPs) was assessed using self-administered questionnaires. RESULTS: The intervention group improved on all eight of the structure-of-care indicators when compared to the control group. A positive effect was also found on the extent to which the GPs measured blood pressure in 60-year-old patients and on the use of an MCI for smoking cessation. No effect was found on the completeness of the risk-factor profiles that the GPs assessed in specific groups of high-risk patients. CONCLUSION: The nationwide intervention appeared to improve certain aspects of preventive cardiovascular care. Nevertheless, the National Association of GPs decided to stop the project. This decision was made within the context of discussions about the heavy workloads and insufficient incomes being experienced by GPs.