General health checks in adults for reducing morbidity and mortality from disease

Krogsbøll, Lasse T; Jørgensen, Karsten Juhl; Gøtzsche, Peter C

doi:10.1002/14651858.cd009009.pub3

Cited by 102 publications

(86 citation statements)

References 153 publications

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“…A recent Cochrane systematic review showed that there is no evidence that general checks in uence morbidity or mortality and this is mirrored in our CDSS. [30] The limited number of tests included in the order set for general check-up shifted the test ordering behavior of GPs in the CDSS arm. We also found that inappropriate laboratory test ordering was very high compared to similar studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial

Delvaux

Piessens

Burghgraeve

et al. 2020

Preprint

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BackgroundInappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.MethodsThis study was a pragmatic, cluster randomized, open label, controlled clinical trial.Setting280 general practitioners (GPs) from 72 primary care practices in Belgium.PatientsPatients aged 18 years with a laboratory test order for at least one of 17 indications; cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication.InterventionsThe CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician.MeasurementsThe primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume and cascade activities.ResultsCDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16 - 0.26, p<.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37 - 10.93, p=.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease - 0.05% increase) in possible diagnostic error.ConclusionsA CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error. Trial RegistrationClinicaltrials.gov Identifier: NCT02950142

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Section: Discussionmentioning

confidence: 99%

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial

Delvaux

Piessens

Burghgraeve

et al. 2020

Preprint

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“…Screening programmes in the form of primary and secondary prevention general health checks have been investigated28 and found to have limited effects on hard endpoints. The current results show that a high-tech hospital-based programme is strongly preferred by individuals even when the mortality risk reduction was held even between different locations.…”

Section: Discussionmentioning

confidence: 99%

Individual preferences on the balancing of good and harm of cardiovascular disease screening

Hansen

Lindholt

Diederichsen

et al. 2019

Heart

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ObjectiveTransition towards value-based healthcare requires insight into what makes value to the individual. The aim was to elicit individual preferences for cardiovascular disease screening with respect to the difficult balancing of good and harm as well as mode of delivery.MethodsA discrete choice experiment was conducted as a cross-sectional survey among 1231 male screening participants at three Danish hospitals between June and December 2017. Participants chose between hypothetical screening programmes characterised by varying levels of mortality risk reduction, avoidance of overtreatment, avoidance of regretting participation, screening duration and location. A multinomial mixed logit model was used to model the preferences and the willingness to trade mortality risk reduction for improvements on other characteristics.ResultsRespondents expressed preferences for improvements on all programme characteristics. They were willing to give up 0.09 (95% CI 0.08 to 0.09) lives saved per 1000 screened to avoid one individual being over treated. Similarly, respondents were willing to give up 1.22 (95% CI 0.90 to 1.55) or 5.21 (95% CI 4.78 to 5.67) lives saved per 1000 screened to upgrade the location from general practice to a hospital or to a high-tech hospital, respectively. Subgroup analysis revealed important preference heterogeneity with respect to smoking status, level of health literacy and self-perceived risk of cardiovascular disease.ConclusionsIndividuals are able to express clear preferences about what makes value to them. Not only health benefit but also time with health professionals and access to specialised facilities were important. This information could guide the optimal programme design in search of value-based healthcare.

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“…In Deutschland werden seit Jahrzehnten, wie in anderen Ländern auch [19], präventive Leistungen im Rahmen von Gesundheitsuntersuchungen (GU) in der Routineversorgung durch Hausarztpraxen erbracht und extrabudgetär honoriert. Diese Leistung gehört gegenwärtig zu den 20 am meisten verwendeten hausärztlichen Gebührenordnungspositionen (GOP) [20].…”

Section: Hintergrundunclassified

Demenzprävention und hausärztliche Versorgung: Schätzung der Zielpopulation

Bohlken¹,

Riedel‐Heller²,

Gothe

et al. 2020

Fortschr Neurol Psychiatr

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Hintergrund Die Demenzprävention, insbesondere die kardiovaskulare Prävention kognitiver Störungen, gerät zunehmend mehr ins Blickfeld der Versorgungsforschung. Ziel dieser Studie ist die Ermittlung der möglichen Zielpopulation für demenzpräventive Ansätze sowie der Häufigkeit der Gesundheitsuntersuchungen (GU) in den einzelnen Hausarztpraxen (HA). Methode 987 Hausarztpraxen, die 2018 für die deutschlandweite IMS Disease Analyzer Datenbank (IQVIA) Daten geliefert haben, wurden bezüglich der Prävalenz folgender Diagnosen untersucht, die als Risikofaktoren für die Entwicklung von demenziellen Erkrankungen gelten: Hypertonie, Adipositas, Hörstörung jeweils im Alter von 45–65 und Diabetes und Depression im Alter über 65 Jahre. Darüber hinaus wurde erfasst, wie viele dieser Patienten eine Gesundheitsuntersuchung (GU) erhielten. Ergebnisse In einer Stichprobe von 2398405 hausärztlich versorgten Patienten bestand die für demenzpräventive Maßnahmen relevante Zielpopulation 2018 aus 191883 Patienten mit Hypertonie, 23308 mit Adipositas, 5059 mit Hörstörung, 120200 mit Diabetes und 43233 mit Depression. Bei über einem Viertel dieser Patienten erfolgte bereits eine GU. Bezogen auf die einzelne Hausarztpraxis, wurden 2018 n am häufigsten Patienten mit Hypertonie (N = 51), Diabetes (N = 30,5) und Depression (N = 11,3) behandelt, seltener Patienten mit Adipositas (N = 8,2) und Hörstörung (N = 1,6). Diskussion und Schlussfolgerung Auf der Grundlage bestimmter Diagnosen in bestimmten Lebensphasen kann eine überschaubare Kerngruppe von Hausarztpatienten identifiziert werden, die für spezifische demenzpräventive Interventionen infrage kommen. Eine Implementierung demenzpräventiver Interventionen in den Praxen wird bei den selteneren Behandlungsdiagnosen Adipositas und Hörstörung schwieriger sein als bei den wesentlich häufigeren Behandlungsdiagnosen Hypertonie, Diabetes und Depression.

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General health checks in adults for reducing morbidity and mortality from disease

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 102 publications

References 153 publications

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial

Individual preferences on the balancing of good and harm of cardiovascular disease screening

Demenzprävention und hausärztliche Versorgung: Schätzung der Zielpopulation

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