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.

The clinical pathway for hypertensive patient of local health unit, hospitals and general practitioners, the Milan experience.

The Clinical Pathway (in its complete definition Diagnostic, Clinical and Therapeutic Pathway - Percorso Diagnostico Terapeutico Assistenziale - PDTA), originally started to deal with the newly diagnosed hypertensive patient, developed also recommendations for the first-line drugs in case of specific indications/contraindications and organ damages. It has been developed by a working group of specialists in cardiology, nephrology, internal medicine (faculty included) designated by their hospitals (both public and private accredited), including all the main city hospitals, by general practitioners designated by the Medical Unions SNAMI, FIMMG, SMI and SiMI and by public health doctors belonging to the Local Health Unit of Milan, who have coordinated the proceedings and have guaranteed that possible conflicts of interest of single participants could not interfere with the PDTA, anyway approved by all in July 2009. The PDTA deals with the measuring and self- home-monitoring of blood pressure (BP) and the diagnosis of hypertension; it revises, sometimes "dries up" and rationalizes the recommendations for diagnostic tests and specialist evaluations; it develops prevention and non-pharmacological treatments, proposing also tools for patients and for prescribing correct nutrition and physical activity and a structured program for BP monitoring; but the main feature is the innovations brought in the proposed drug treatment in comparison with the current clinical practice.