Targeted prevention in primary care aimed at lifestyle-related diseases: a study protocol for a non-randomised pilot study

Abstract

BackgroundThe consequences of lifestyle-related disease represent a major burden for the individual as well as for society at large. Individual preventive health checks to the general population have been suggested as a mean to reduce the burden of lifestyle-related diseases, though with mixed evidence on effectiveness. Several systematic reviews, on the other hand, suggest that health checks targeting people at high risk of chronic lifestyle-related diseases may be more effective. The evidence is however very limited. To effectively target people at high risk of lifestyle-related disease, there is a substantial need to advance and implement evidence-based health strategies and interventions that facilitate the identification and management of people at high risk. This paper reports on a non-randomized pilot study carried out to test the acceptability, feasibility and short-term effects of a healthcare intervention in primary care designed to systematically identify persons at risk of developing lifestyle-related disease or who engage in health-risk behavior, and provide targeted and coherent preventive services to these individuals.MethodsThe intervention took place over a three-month period from September 2016 to December 2016. Taking a two-pronged approach, the design included both a joint and a targeted intervention. The former was directed at the entire population, while the latter specifically focused on patients at high risk of a lifestyle-related disease and/or who engage in health-risk behavior. The intervention was facilitated by a digital support system. The evaluation of the pilot will comprise both quantitative and qualitative research methods. All outcome measures are based on validated instruments and aim to provide results pertaining to intervention acceptability, feasibility, and short-term effects.DiscussionThis pilot study will provide a solid empirical base from which to plan and implement a full-scale randomized study with the central aim of determining the efficacy of a preventive health intervention.Trial registrationRegistered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016). Registered 29 April 2016. The study adheres to the SPIRIT guidelines.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0820-8) contains supplementary material, which is available to authorized users.

‘Motivational work’: a qualitative study of preventive health dialogues in general practice

“…The process evaluation was part of a pilot study that aimed to test the acceptability, feasibility, and short-term effects of the so-called 'TOF intervention' (a Danish acronym for 'Early Detection and Prevention'). The intervention systematically identifies individuals at high risk of lifestyle-related disease and provides targeted and coherent preventive services in the primary healthcare sector, including general practice [16].…”

“…Early detection and the provision of coherent preventive services are expected to diminish the individual and societal burden of chronic disease [16]. To achieve this, the TOF pilot study consisted of 1) a stratification into one of four groups based on results from an online questionnaire to patients (see Table 1), 2) a digital support system for both GPs and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center.…”

“…The health dialogues lasted approximately 30 minutes and were based on the results from the clinical examination, the remarks in the digital health profile, and the patient's answers to questions in the questionnaires [16]. During the health dialogues, GPs were required to base the dialogue on a number of topics provided by the digital health profile to ensure that all adverse health behaviors identified in the questionnaire and health examination were considered and handled.…”

“…MI was followed in order to uncover patients' motivation, wishes, understandings and priorities in terms of their own health in a patient-centered dialogue [20]. In this line of thinking, the GPs' role in the TOF pilot study was to 1) motivate and advise patients to change health-risk behavior without taking over responsibility for their actions, 2) to help patients clarify their prospective health-risk behavioral changes, and 3) to enter goal-setting and action-planning in the digital health profile during the dialogues [16]. Although the health dialogues were based on the elements of MI, the GPs did not receive any training in using MI prior to the intervention.…”

Association of osteoarthritis risk factors with knee and hip pain in a population-based sample of 2424 30–59 year olds in Denmark: a cross-sectional analysis.

“…The TOF study is a population-based study on residents from the Region of Southern Denmark [17]. Almost all Danish residents are listed with a general practitioner (GP) [18].…”