Abstract
BackgroundUntil now, cardiometabolic risk assessment in Dutch primary health care was directed at case-finding, and structured, programmatic prevention is lacking. Therefore, the Prevention Consultation cardiometabolic risk (PC CMR), a stepwise approach to identify and manage patients with cardiometabolic risk factors, was developed. The aim of this study was 1) to evaluate uptake rates of the two steps of the PC CMR, 2) to assess the rates of newly diagnosed hypertension, hypercholesterolemia, diabetes mellitus and chronic kidney disease and 3) to explore reasons for non-participation.MethodsSixteen general practices throughout the Netherlands were recruited to implement the PC CMR during 6 months. In eight practices eligible patients aged between 45 and 70 years without a cardiometabolic disease were actively invited by a personal letter (‘active approach’) and in eight other practices eligible patients were informed about the PC CMR only by posters and leaflets in the practice (‘passive approach’). Participating patients completed an online risk estimation (first step). Patients estimated as having a high risk according to the online risk estimation were advised to visit their general practice to complete the risk profile with blood pressure measurements and blood tests for cholesterol and glucose and to receive recommendations about risk lowering interventions (second step).ResultsThe online risk estimation was completed by 521 (33%) and 96 (1%) of patients in the practices with an active and passive approach, respectively. Of these patients 392 (64%) were estimated to have a high risk and were referred to the practice; 142 of 392 (36%) consulted the GP. A total of 31 (22%) newly diagnosed patients were identified. Hypertension, hypercholesterolemia, diabetes and chronic kidney disease were diagnosed in 13%, 11%, 1% and 0%, respectively. Privacy risks were the most frequently mentioned reason not to participate.ConclusionsOne third of the patients responded to an active invitation to complete an online risk estimation. A passive invitation resulted in only a small number of participating patients. Two third of the participants of the online risk estimation had a high risk, but only one third of them attended the GP office. One in five visiting patients had a diagnosed cardiometabolic risk factor or disease.
Highlights
Until now, cardiometabolic risk assessment in Dutch primary health care was directed at case-finding, and structured, programmatic prevention is lacking
Cardiovascular disease, diabetes mellitus and chronic kidney disease and cardiovascular mortality are highly associated with modifiable lifestyle factors such as smoking, physical inactivity and poor diet [4,5]
Patients Sixteen general practices (49 general practitioners (GPs) and 27 practice nurses) were recruited who were willing to implement the prototype of the PC Prevention Consultation cardiometabolic risk (CMR)
Summary
Cardiometabolic risk assessment in Dutch primary health care was directed at case-finding, and structured, programmatic prevention is lacking. Cardiovascular disease, diabetes mellitus and chronic kidney disease (further referred to as “cardiometabolic disease”) and cardiovascular mortality are highly associated with modifiable lifestyle factors such as smoking, physical inactivity and poor diet [4,5]. In the Netherlands, more than a quarter of the population currently smokes and about half of all people are overweight or obese [6,7]. These risk factors, together with biomedical indices such as glucose and cholesterol levels, blood pressure level and the family history of cardiometabolic disease [8] generate a personal risk profile which predicts the future development of cardiovascular disease and diabetes mellitus. The metabolic syndrome, with the hypertriglyceridaemic waist as its most prominent clinical criterion, is a contributing factor to global cardiometabolic risk [9]
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