What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group

Norbert Král,Anne-Karien M De Waard,François G Schellevis,Joke C Korevaar,Christos Lionis,Axel C Carlsson,Anders Larrabee Sønderlund,Jens Søndergaard,Lars Bruun Larsen,Monika Hollander,Trine Thilsing,Agapi Angelaki,Niek J De Wit,Bohumil Seifert

doi:10.1080/13814788.2019.1641195

Abstract

Background: Selective prevention of cardiometabolic diseases (CMD)—that is, preventive measures specifically targeting the high-risk population—may represent the most effective approach for mitigating rising CMD rates.Objectives: To develop a universal concept of selective CMD prevention that can guide implementation within European primary care.Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round.Results: In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated.Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.

Highlights

Cardiometabolic disease is a major public health issue worldwide
The 32 statements that were drafted by the SPIMEU project team covered all key aspects of selective cardiometabolic diseases (CMD) prevention, divided into four domains: (1) background; (2) organization and funding; (3) target group, and methods of identification of risk groups; and (4) provision of selective CMD prevention
We developed a concept for a selective CMD prevention programme, rooted in 31 statements based on scientific literature which were adopted through a systematic consensus procedure

Summary

Introduction

Cardiometabolic disease (cardiovascular disease, diabetes mellitus, and chronic kidney disease; CMD) is a major public health issue worldwide. The most prominent challenge in selective prevention is how to efficiently identify persons at increased risk in the general population, in order to start the indicated prevention activities [11,12]. Selective prevention of cardiometabolic diseases (CMD)—that is, preventive measures targeting the high-risk population—may represent the most effective approach for mitigating rising CMD rates. Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated. Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care. There is limited evidence that a proactive approach (Statement 4) is effective in CMD prevention [6,9,21,22]

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Conclusion