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Effectiveness of a Cardiometabolic Prevention Program in Integrated Care Practices

Study on the preliminary effect of a cardiometabolic prevention program in integrated care practices, focusing on lifestyle improvements and risk communication. Results show accurate treatment of newly detected cardiometabolic risks by GPs, but lifestyle improvements remain a challenge.

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Effectiveness of a Cardiometabolic Prevention Program in Integrated Care Practices

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  1. The effectiveness of a cardiometabolic prevention program in general practices offering integrated care programs Dr. M.Hollander Drs. L.Eppink Dr. M.Nielen Drs. I Badenbroek Drs. D Stol Prof. N de Wit Prof. F Schellevis WONCA 2016

  2. Background • Increasing number cardio-metabolic diseases • Overlapping lifestyle-related risk factors: • Overweight • Unhealthy diet • Physical inactivity • Smoking • How effective is a CMD prevention program in health centers that offer integrated lifestyle treatment?

  3. Aim & Methods • Objective: • To study the preliminary effect of PC CMR in the Julius Health centers offering integrated care programs incl. lifestyle • Used methods • Randomised clinical trial with stepped wedge design incl waiting list control group • Prospective study on process and outcomes of PCCMR in 4 Julius Health Centers during 1 year follow-up • Sources: outcomes of questionnaires and medical files of GPs.

  4. Low risk Lifestyle advice Questionnaire: - Smoking - Family history CVD - Age - Gender - Waist circumference - BMI ‘Healthy population’ 45-70 years old Tailor-made Lifestyle advice + local prevention programs Intermediate risk High risk PREVENTIVE CONSULTATION 1 • Check questionnaire + talk about risk • Measure risk factors • Referral to lab PREVENTION CONSULTATION 2 • Make up risk profile • Assess lifestyle • Risk communication, advice Treatment in primary care + local programs according to: • Guideline and disease management programs on CVD, Diabetes and Chronic Kidney Diseases • Smoking cessation; Physical exercise; Healthy nutrition Prevention Consultation CMD

  5. Questionnaire: - Smoking - Family history CVD - Age - Gender - Waist circumference - BMI ‘Healthy population’ 45-70 years old Waiting list Control group No feedback on result, waiting list foroneyear

  6. 4170 patients 45-70 years without history of CMD Intervention Group N = 2332 Control Group N = 1838 31% 26% Response Risk Test N = 729 Response Risk Test N = 481 78% 22% 78% 22% High Risk N = 162 (7% of total) N High Risk N = 105 N L Low Risk N = 376 N Low Risk N = 567 Resultsinvitationfor PC-CMR 31% 26% 22% 22%

  7. Visits to the GP office

  8. Visits to the GP office

  9. Effect on bloodpressure

  10. Effect on LDL and glucose

  11. Effect on BMI

  12. Effect on BMI smoking andexercise

  13. A new CMD is diagnosed in one fifth of patients visiting the practice after an online risk assessment test Filling in a questionnaire itself is a trigger to visit the GP for CMD risk Newly detected CMD risk is accurately treated by the GP Lifestyle improvements remain a challenge Focus is needed on improving the response Conclusions

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