Step-wise approach to prevention of chronic diseases in the Danish primary care sector with the use of a personal digital health profile and targeted follow-up – an assessment of attendance

Larsen, Lars Bruun; Søndergaard, Jens; Thomsen, Janus Laust; Halling, Anders; Sønderlund, Anders Larrabee; Christensen, Jeanette Reffstrup; Thilsing, Trine

doi:10.1186/s12889-019-7419-4

Cited by 27 publications

(33 citation statements)

References 52 publications

(57 reference statements)

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“…A total of 93 high risk patients attended the clinical examination and subsequent health check consultation at their GP. More women, patients with sedentary leisure-time behaviour and patients with low self-efficacy attended the health checks [24]. Sixty patients subsequently answered the CARE and PEI questionnaires and 49 also completed the 3 months follow-up.…”

Section: Resultsmentioning

confidence: 99%

Does GP empathy influence patient enablement and success in lifestyle change among high risk patients?

et al. 2020

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Background: Chronic lifestyle-related-diseases can be prevented by healthy lifestyle. Patients at high risk of disease may benefit from targeted health checks in general practice. However, general-practice-based-studies have shown that patient outcome, enablement, and well-being may be influenced by general practitioner (GP) empathy. The aim of this study is to investigate 1) how high risk patients evaluate their GPs' empathy during a health check consultation, 2) whether the perceived GP empathy is associated with the patient's enablement in immediate continuation of the health check consultation and 3) the patient's subsequent lifestyle changes. Methods: This study is part of a population based non-randomized feasibility study testing a complex intervention that systematically identifies citizens at high risk of lifestyle-related disease and with health-risk behavior and offers targeted preventive services in the Danish primary care sector. The ultimate aim of the intervention is to improve lifestyle and thereby reduce the risk of lifestyle-related disease. In the feasibility study a random sample of patients aged 30 to 59 years were invited to participate, and to fill in a questionnaire on lifestyle-risk factors. Participants deemed to be at high risk of disease were offered a focused clinical examination and a subsequent health check consultation at the GP. Following each health check consultation GP empathy and patient enablement were assessed using The Care Measure (CARE) and Patient Enablement Instrument (PEI). Patient's perceived healthylifestyle change (y/n) was assessed after three months. The study has been approved by the Danish Data Protection Agency (J.nr 2015-57-0008) and registered at ClinicalTrial. Gov on June 13, 2016. Results: Twenty-six GP's participated in the study. Among 93 patients receiving a health check consultation 60 rated the GPs empathy. The median CARE-score was 40. The PEI median was 5.5 and 44.9% achieved a healthier lifestyle. No association was observed between GP empathy and patient enablement or a perceived healthier lifestyle. Conclusion: No statistical significant association between the CARE-score and patient enablement or a perceived healthier lifestyle was observed. Our results contrast previous findings and may to some extent be explained by a small sample size and the selected high-risk group. Trial registration number: NCT02797392.

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Section: Resultsmentioning

confidence: 99%

Does GP empathy influence patient enablement and success in lifestyle change among high risk patients?

et al. 2020

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“…Of these, 582 were deemed to be at high risk (group 2) and were offered the targeted intervention at their GP. Another 618 patients engaged in health-risk behaviors (group 3) and were offered the targeted intervention at the MHC [ 28 ]. At 1-year follow-up, 56.2% (327/582) of patients from the high-risk group and 43.9% (271/618) from the health-risk behavior group responded to the questionnaire ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Changes in Health-Risk Behavior, Body Mass Index, Mental Well-Being, and Risk Status Following Participation in a Stepwise Web-Based and Face-to-Face Intervention for Prevention of Lifestyle-Related Diseases: Nonrandomized Follow-Up Cohort Study

Thilsing¹,

Sønderlund²,

Søndergaard³

et al. 2020

JMIR Public Health Surveill

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Background Recent evidence suggests the effectiveness of stepwise, targeted approaches for the prevention of lifestyle-related diseases with combinations of web-based and face-to-face interventions showing promising results. Objective This paper reports on 1-year changes in health-risk behaviors, BMI, self-rated health, mental well-being, and risk of disease at 1-year follow-up after participation in a stepwise intervention that targeted persons at high risk of disease and persons with health-risk behavior. To this end, we distinguish between participants who took up the full intervention (web-based plus face-to-face) and those who received only the web-based intervention. Methods The Early Detection and Prevention (Danish acronym: TOF) pilot study was conducted as a nonrandomized, 1-year follow-up intervention study in two municipalities in the Region of Southern Denmark. A total of 9400 citizens born between 1957 and 1986 (aged 29 to 60 years) were randomly sampled from participating general practitioner (GP) patient-list systems and were invited to take part in the study. Participants were subsequently stratified into risk groups based on their responses to a questionnaire on health-risk behavior and data from their GP’s electronic patient record (EPR) system. All participants received a digital personal health profile with individualized information on current health-risk behavior and targeted advice on relevant health-risk behavior changes. In addition, patients at high risk of disease, as indicated by their digital health profile, were offered a targeted intervention at their GP. Patients who were not deemed at high risk of disease but who exhibited health-risk behaviors were offered a targeted intervention at their municipal health center (MHC). At 1-year follow-up, health-risk behaviors, self-rated health, BMI, and mental well-being were reassessed by questionnaire, and current information on diagnoses and medical treatment was retrieved from the EPRs. Results Of 598 patients at high risk of disease or with health-risk behavior, 135 took up the targeted intervention at their GP or MHC and 463 received the personal health profile only. From baseline to 1-year follow-up, the number of patients with unhealthy eating habits decreased, mean mental well-being increased, and smoking prevalence decreased in patients who had received the digital personal health profile alone. Among patients who took up the targeted intervention, unhealthy eating habits and sedentary lifestyles decreased and significant reductions in mean BMI were observed. At 1-year follow up, no health-risk behaviors were detected among 17.4% of patients who at baseline had exhibited health-risk behaviors or high risk of disease. Conclusions A stepwise targeted preventive approach using web-based and face-to-face elements may lead to favorable lifestyle changes. Specifically, a web-based approach may improve smoking and eating habits and mental well-being, whereas supplementary face-to-face interventions may be necessary to improve exercise habits and BMI. Trial Registration ClinicalTrials.gov NCT02797392; https://clinicaltrials.gov/ct2/show/NCT02797392 International Registered Report Identifier (IRRID) RR2-10.1186/s12875-018-0820-8

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“…Furthermore, studies have found that individuals with low self-e cacy were less likely to participate in general heath checks offered by GPs (31,32). By contrast, in a cross-sectional analysis of participation in a study aimed to prevent T2D, CVD and chronic obstructive pulmonary disease, Larsen et al (33) found that lower selfe cacy was associated with a higher likelihood of getting health checks. We found that self-e cacy per se did not necessarily facilitate participation according to our model, as personal encouragement is also needed.…”

Section: Self-e Cacymentioning

confidence: 99%

Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

Dahl

Soendergaard

Diederichsen

et al. 2020

Preprint

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Background Type 2 diabetes (T2D) is associated with a significant increased risk of cardiovascular disease (CVD). The DIAabetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40–60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting prevention of CVD. Methods We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40–60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis. Results The participants’ experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from proactive to reactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in forthcoming preventive initiatives. Conclusion Encouraging people with T2D to participate in cardiovascular preventive initiatives might necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees’ characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular disease prevention. Our proposed model may be applicable in preventive services for people with T2D in general.

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Step-wise approach to prevention of chronic diseases in the Danish primary care sector with the use of a personal digital health profile and targeted follow-up – an assessment of attendance

Cited by 27 publications

References 52 publications

Does GP empathy influence patient enablement and success in lifestyle change among high risk patients?

Does GP empathy influence patient enablement and success in lifestyle change among high risk patients?

Changes in Health-Risk Behavior, Body Mass Index, Mental Well-Being, and Risk Status Following Participation in a Stepwise Web-Based and Face-to-Face Intervention for Prevention of Lifestyle-Related Diseases: Nonrandomized Follow-Up Cohort Study

Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

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