Effectiveness of clinic-based cardiovascular disease prevention: A randomized encouragement design experiment in the Philippines

Abstract

RationaleEvidence on effectiveness of routine clinic-based cardiovascular disease (CVD) prevention in low- and middle-income countries is lacking. This study aimed to provide evidence on exposure to primary prevention of CVDs obtained through visits to public health clinics in the Philippines that are responsible for operating a widely-adopted CVD risk screening and management protocol. MethodIn a 2018 cluster-randomized experiment in Nueva Ecija province, participants aged 40–70 with no history of CVD in randomly selected communities were offered a money-prize lottery ticket if they visited a public health clinic for a check-up. The induced variation in clinic visits was used to estimate effects of a check-up on exposure to CVD prevention indicators (measurement, diagnosis and medication of physiological CVD risk factors, and medical advice about behavioural risk factors), as well as on health behaviour and predicted 10-year CVD risk score. ResultsGoing for a check-up at a public clinic raised a weighted average of effect sizes of the prevention indicators by 0.16 (95% CI 0.06 to 0.26, FWER-corrected p = 0.0218). Disaggregated analyses revealed positive effects on blood pressure measurement and receipt of medical advice, but no significant effect on diagnosis or medication of either hypertension or diabetes/dyslipidaemia. Despite high baseline prevalence of CVD risk factors and increased receipt of medical advice, there were no significant effects after six months on health behaviour, physiological risk factors or CVD risk score. ConclusionGetting Filipinos to health clinics responsible for opportunistic CVD risk screening had a muted impact on exposure to CVD prevention and no significant impact on health behaviour and predicted CVD risk. Issuing well-founded protocols may be insufficient to ensure exposure to CVD prevention through routine clinic visits.