Abstract
BackgroundCurrent evidence on chronic disease prevention suggests that interventions targeted at high-risk individuals represents the best way forward. We implemented a step-wise approach in the Danish primary care sector, designed for the systematic and targeted prevention of chronic disease. The intervention centered on a personal digital health profile for all participants, followed by targeted preventive programs for high-risk patients. The present paper examines individual characteristics and health-care usage of patients who took up the targeted preventive programs in response to their personal digital health profile.MethodsA sample of patients born between 1957 and 1986 was randomly selected from the patient-list system of participating general practitioners in two Danish municipalities. The selected patients received a digital invitation to participate. Consenting patients received a second digital invitation for a personal digital health profile based on questionnaire and electronic patient record data. The personal digital health profile contained individualized information on risk profile and personalized recommendations on further actions. If at-risk or presenting with health-risk behaviour a patient would be advised to contact either their general practitioner or municipal health centre for targeted preventive programs. Attendance at the targeted preventive programs was examined using Poisson regression and chi-squared automatic interaction detection methods.ResultsA total of 9400 patients were invited. Of those who participated (30%), 22% were advised to get a health check at their general practitioner. Of these, 19% did so. Another 23% were advised to schedule an appointment for behaviour-change counselling at their municipal health centre. A total of 21% took the advice. Patients who had fair or poor self-rated health, a body mass index above 30, low self-efficacy, were female, non-smokers, or lead a sedentary lifestyle, were most likely to attend the targeted preventive programs.ConclusionsA personal digital health profile shows some promise in a step-wise approach to prevention in the Danish primary care sector and seems to motivate people with low self-efficacy to attend targeted preventive programs.Trial registrationRegistered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016). Prospectively registered on the 29th of April 2016.
Highlights
Current evidence on chronic disease prevention suggests that interventions targeted at high-risk individuals represents the best way forward
586 patients were excluded from the sample as they could not be contacted by digital mail and/or resided outside of the municipalities of Varde or Haderslev
Our results show that being female, having sedentary behaviour and low self-efficacy were associated to attendance at a health check at their general practitioner (GP)
Summary
Current evidence on chronic disease prevention suggests that interventions targeted at high-risk individuals represents the best way forward. General health checks to prevent type-2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) have shown no population-level effects above and beyond those attained by opportunistic case finding [1, 2] It is well-known that as the absolute risk of CVD increases, so too does the protective effect of both health-behaviour change and preventive treatment [3,4,5]. Advanced digital technology and infrastructure have only recently made such targeted approaches possible without putting too much strain on available human and economic resources Most importantly, these advances may facilitate individual risk assessment using information already available in healthcare databases or non-clinical health information. Examples of this added utility include the English National Health Services (NHS) in their health check program [7], as well as the Dutch cardio-metabolic disease (CMD) program [8]
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