Selective prevention of cardiometabolic diseases: activities and attitudes of general practitioners across Europe

Abstract

Although most GPs considered selective CMD prevention as useful, it was not universally implemented. The biggest challenge was the process of inviting individuals for risk assessment. It is important to tailor the implementation of selective CMD prevention in primary care to the national context, involving stakeholders at different levels.

What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group

“…The SPIMEU project team (the authors of this article) formulated a set of statements based on the literature, including synthesis of evidence from two literature reviews on barriers to, and facilitators of, selective cardiometabolic prevention among professionals and patients [15,15], and the results of surveys among experts, health professionals and patients about attitudes and practices of selective CMD prevention in the EU [16]. In the next step, following the methodology, the expert panel was set up.…”

An evidence-based toolbox for the design and implementation of selective-prevention primary-care initiatives targeting cardio-metabolic disease

“…In WP A (Hollander and de Waard, In press), we examined the practical and structural organization of past and current SPIs in Europe. We then investigated the barriers and facilitators of patient (de Waard et al, 2018a) and GP (de Waard et al, 2018b; Wändell et al, 2018) attitudes to selective prevention of CMD (WP B & C, respectively). In WP D and E, we developed (Kral et al, In press) and feasibility tested (Lionis et al, 2018) a generic CMD-SPI in the five partner countries.…”

“…Most common facilitators were positivity towards prevention. Patients : Demographic and attitudinal factors predicted CMD-SPI uptake. Barriers and facilitators overlapped, but varied across countries.CAssessment of GPs' use of SPIs, and GP and patient attitudes towards selective prevention in the five partner countries (de Waard et al, 2018a; de Waard et al, 2018b). Design : Two cross-sectional survey studies, one on GPs and one on patients. Participants : 575 GPs & 1354 patients, divided evenly across five SPIMEU countries.GP study:Most GPs had a positive attitude to CMD-SPI use and usefulness (84%).Most invited patients for health check (71%) and did so opportunistically (53%) and/or actively (48%).Most GPs had a disease management program for high-risk patients (86%).Patient invitation was the biggest obstacle for GP implementation of CMD-SPIs.Patient study:On average, 9% of patients were unwilling to participate in CMD-SPIs.Overall, being male, a smoker, having high self-rated health, having no history of health assessments, and unwillingness to pay for health check predicted lower participation.Patients preferred GP invitation and willingness to pay ranged from 49 to 81% across countries.Eagerness to know one's own risk profile was the main motivation for participation. GPs : Most GPs considered CMD-SPIs as useful and necessary.…”

Unfulfilled potential of primary care in Europe

“…Early general practitioners such as William Pickles and Frans Huijgen felt responsible for population and individual level practice,22 but the role of contemporary primary care teams is much narrower in many European countries 11232425. Sutchfield and colleagues argue that an overemphasis on specialisation and the evolving professionalisation of primary care and public health as distinct specialties during the 20th century led to GPs eschewing public health roles 26.…”