BACKGROUND: Cardiometabolic diseases (CMDs) are the number one cause of death. Selective prevention of CMDs by general practitioners (GPs) could help reduce the burden of CMDs. This measure would entail the identification of individuals at high risk of CMDs-but currently asymptomatic-followed by interventions to reduce their risk. No data were available on the attitude and the extent to which European GPs have incorporated selective CMD prevention into daily practice. METHODS: A survey among 575 GPs from the Czech Republic, Denmark, Greece, the Netherlands and Sweden was conducted between September 2016 and January 2017, within the framework of the SPIMEU-project. RESULTS: On average, 71% of GPs invited their patients to attend for CMD risk assessment. Some used an active approach (47%) while others used an opportunistic approach (53%), but these values differed between countries. Most GPs considered selective CMD prevention as useful (82%) and saw it as part of their normal duties (84%). GPs who did find selective prevention useful were more likely to actively invite individuals compared with their counterparts who did not find prevention useful. Most GPs had a disease management programme for individuals with risk factor(s) for cardiovascular disease (71%) or diabetes (86%). CONCLUSIONS: Although most GPs considered selective CMD prevention as useful, it was not universally implemented. The biggest challenge was the process of inviting individuals for risk assessment. It is important to tailor the implementation of selective CMD prevention in primary care to the national context, involving stakeholders at different levels.

Clinic of Social and Family Medicine School of Medicine University of Crete Greece

Department of General Practice and Elderly Care Medicine Amsterdam Public Health Research Institute VU University Medical Center Amsterdam The Netherlands

Department of General Practice Julius Center University Medical Center Utrecht Utrecht University Utrecht The Netherlands

Department of Medical Sciences Cardiovascular Epidemiology Uppsala University Uppsala Sweden

Division of Family Medicine and Primary Care Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden

Institute of General Practice 1st Faculty of Medicine Charles University Prague The Czech Republic

Nivel Utrecht The Netherlands

Research Unit of General Practice Department of Public Health University of Southern Denmark Odense C Denmark

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Cardiovascular diseases [Internet], 2016. Available at: http://www.who.int/mediacentre/factsheets/fs317/en/ (24 February 2017, date last accessed).

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4–14. PubMed

James WP. The epidemiology of obesity: the size of the problem. J Intern Med 2008;263:336–52. PubMed

Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001;104:2746–53. PubMed

Deaton C, Froelicher ES, Wu LH, et al.The global burden of cardiovascular disease. Eur J Cardiovasc Nurs 2011;10:S5–13. PubMed

World population ageing 1950–2050 [Internet], 2002. Available at: http://www.un.org/esa/population/publications/worldageing19502050/ (1 July 2017, date last accessed).

Si S, Moss JR, Sullivan TR, et al.Effectiveness of general practice-based health checks: a systematic review and meta-analysis. Br J Gen Pract 2014;64:e47–53. PubMed PMC

Unal B, Critchley JA, Capewell S. Modelling the decline in coronary heart disease deaths in england and wales, 1981–2000: comparing contributions from primary prevention and secondary prevention. BMJ 2005;331:614. PubMed PMC

Piepoli MF, Hoes AW, Agewall S, et al.2016 European Guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37:2315–81. PubMed PMC

Krogsboll LT, Jorgensen KJ, Gronhoj LC, et al.General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2012;10:CD009009. PubMed

Forster AS, Burgess C, Dodhia H, et al.Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records. J Public Health (Oxf) 2016;38:552–9. PubMed PMC

Action Plan for Implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012−2016 [Internet], 2012. Available at: http://www.euro.who.int/en/publications/abstracts/action-plan-for-implementation-of-the-european-strategy-for-the-prevention-and-control-of-noncommunicable-diseases-20122016.

Website SPIMEU project [Internet], 2017. Available at: www.spimeu.org (1 July 2017, date last accessed).

Nielen MM, Assendelft WJ, Drenthen AJ, et al.Primary prevention of cardio-metabolic diseases in general practice: a Dutch survey of attitudes and working methods of general practitioners. Eur J Gen Pract 2010;16:139–42. PubMed

Godefrooij M, Spigt M, van der Minne W, et al.Implementing cardiometabolic health checks in general practice: a qualitative process evaluation. BMC Fam Pract 2014;15:132. PubMed PMC

Schafer WL, Boerma WG, Spreeuwenberg P, et al.Two decades of change in European general practice service profiles: conditions associated with the developments in 28 countries between 1993 and 2012. Scand J Prim Health Care 2016;34:97–110. PubMed PMC

Kringos D, Boerma W, Bourgueil Y, et al.The strength of primary care in Europe: an international comparative study. Br J Gen Pract 2013;63:e742–50. PubMed PMC

Všeobecná preventivní prohlídka (general preventive surveillance) [Internet]. Available at: https://www.vzp.cz/pojistenci/prevence/preventivni-prohlidky/vseobecna-preventivni-prohlidka.

SCORE Risk Chart [Internet], 2012. Available at: https://www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/SCORE-Risk-Charts (15 December 2017, date last accessed).

Dallongeville J, Banegas JR, Tubach F, et al.Survey of physicians' practices in the control of cardiovascular risk factors: the EURIKA study. Eur J Prev Cardiol 2012;19:541–50. PubMed

Danish score cart [Internet], 2007. Available at: http://www.dsam.dk/files/9/iskaemisk_hjerte_kar_sygdom_2007.pdf (23 January 2018, date last accessed).

Panagiotakos DB, Georgousopoulou EN, Fitzgerald AP, et al.Validation of the HellenicSCORE (a calibration of the ESC SCORE project) regarding 10-year risk of fatal cardiovascular disease in greece. Hellenic J Cardiol 2015;56:302–8. PubMed

Dutch risk table for cardiovascular risk management [Internet], 2012. Available at: https://www.nhg.org/standaarden/samenvatting/cardiovasculair-risicomanagement (23 January 2018, date last accessed).

Doolan-Noble F, Tracey JF, Mann S. Why are there gaps in our management of those with high cardiovascular risk? J Primary Health Care 2012;4:2–9. PubMed

Laurant M, Reeves D, Hermens R, et al.Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev 2005;2:CD001271. PubMed

Hiligsmann M, Wyers CE, Mayer S, et al.A systematic review of economic evaluations of screening programmes for cardiometabolic diseases. Eur J Public Health 2017;27:621–631. PubMed

Templeton L, Deehan A, Taylor C, et al.Surveying general practitioners: does a low response rate matter? Br J Gen Pract 1997;47:91–4. PubMed PMC

mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): rationale and study protocol for a pragmatic randomised controlled trial

High Variability in Implementation of Selective-Prevention Services for Cardiometabolic Diseases in Five European Primary Care Settings

An evidence-based toolbox for the design and implementation of selective-prevention primary-care initiatives targeting cardio-metabolic disease

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