Cardio-metabolic diseases (CMD; cardiovascular disease, type 2 diabetes, chronic kidney disease) represent a global public health problem. Worldwide, nearly half a billion people are currently diagnosed with diabetes, and cardiovascular disease is the leading cause of death. Most of these diseases can be assuaged/prevented through behavior change. However, the best way to implement preventive interventions is unclear. We aim to fill this knowledge gap by creating an evidence-based and adaptable "toolbox" for the design and implementation of selective prevention initiatives (SPI) targeting CMD. We built our toolbox based on evidence from a pan-European research project on primary-care SPIs targeting CMD. The evidence includes (1) two systematic reviews and two surveys of patient and general practitioner barriers and facilitators of engaging with SPIs, (2) a consensus meeting with leading experts to establish optimal SPI design, and (3) a feasibility study of a generic, evidence-based primary-care SPI protocol in five European countries. Our results related primarily to the five different national health-care contexts from which we derived our data. On this basis, we generated 12 general recommendations for how best to design and implement CMD-SPIs in primary care. We supplement our recommendations with practical, evidence-based suggestions for how each recommendation might best be heeded. The toolbox is generic and adaptable to various national and systemic settings by clinicians and policy makers alike. However, our product needs to be kept up-to-date to be effective and we implore future research to add relevant tools as they are developed.

Clinic of Social and Family Medicine University of Crete Rethymno Greece

Division of Family Medicine and Primary Care Department of Neurobiology Care Sciences and Society H1 Karolinska Institutet Stockholm Sweden

Institute of General Practice Charles University Prague Prague Czech Republic

Julius Center for Health Sciences and Primary Care University Medical Center Utrecht the Netherlands

Netherlands Institute for Health Services Research Utrecht the Netherlands

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

Zobrazit více v PubMed

Ampt A.J. Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Fam. Pract. 2009;10(1):59. PubMed PMC

Arena R. Healthy lifestyle interventions to combat noncommunicable disease—a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur. Heart J. 2015;36(31):2097–2109. PubMed

Bandura A. Health promotion by social cognitive means. Health Educ. Behav. 2004;31(2):143–164. PubMed

Björck L. Modelling the decreasing coronary heart disease mortality in Sweden between 1986 and 2002. Eur. Heart J. 2009;30(9):1046–1056. PubMed

Brotons C. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev. Med. 2005;40(5):595–601. PubMed

Cooper R.S. Social inequality, ethnicity and cardiovascular disease. Int. J. Epidemiol. 2001;30(suppl_1):S48. PubMed

Critchley J.A., Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86–97. PubMed

Dalstra J.A. Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int. J. Epidemiol. 2005;34(2):316–326. PubMed

de Waard A.-K.M. Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: a systematic review. Eur. J. Prev. Cardiol. 2018;25(12) PubMed PMC

de Waard A.-K.M. Selective prevention of cardiometabolic diseases: activities and attitudes of general practitioners across Europe. Eur. J. Pub. Health. 2018;29(1) PubMed PMC

Dekker J. Summary of the practice guideline'the prevention visit'from the Dutch College of General Practitioners. Ned. Tijdschr. Geneeskd. 2011;155(18):A3428. PubMed

Di Cesare M. Inequalities in non-communicable diseases and effective responses. Lancet. 2013;381(9866):585–597. PubMed

Diehl K. Physician gender and lifestyle counselling to prevent cardiovascular disease: a nationwide representative study. Journal of Public Health Research. 2015;4(2) PubMed PMC

Doolan-Noble F., Tracey J., Mann S. Why are there gaps in our management of those with high cardiovascular risk? Journal of Primary Health Care. 2012;4(1):21–29. PubMed

Emmons K.M. Social influences, social context, and health behaviors among working-class, multi-ethnic adults. Health Educ. Behav. 2007;34(2):315–334. PubMed

Ferrante D. Barriers to prevention of cardiovascular disease in primary care settings in Argentina. Rev. Panam. Salud Publica. 2013;33:259–266. PubMed

Fitch K. RAND CORP; SANTA MONICA CA: 2001. The RAND/UCLA Appropriateness Method User's Manual.

Fortney J.C. The effects of travel barriers and age on the utilization of alcoholism treatment aftercare. The American Journal of Drug and Alcohol Abuse. 1995;21(3):391–406. PubMed

Galobardes B. Trends in risk factors for lifestyle-related diseases by socioeconomic position in Geneva, Switzerland, 1993–2000: health inequalities persist. Am. J. Public Health. 2003;93(8):1302–1309. PubMed PMC

George P.P. Right-siting chronic kidney disease care-a survey of general practitioners in Singapore. Ann. Acad. Med. Singap. 2013;42(12):646–656. PubMed

Ghosh K. Communications of the Association for Information Systems. Vol. 34. 2014. Media reinforcement for psychological empowerment in chronic disease management; p. 22.

Giesen P. Quality of after-hours primary care in the Netherlands: a narrative review. Ann. Intern. Med. 2011;155(2):108–113. PubMed

Griffith K.A. African Americans with a family history of colorectal cancer: barriers and facilitators to screening. Oncol. Nurs. Forum. 2012;39(3):299–306. PubMed

Grol R., Giesen P., van Uden C. After-hours care in the United Kingdom, Denmark, and the Netherlands: new models. Health Aff. 2006;25(6):1733–1737. PubMed

Haslam C. Routledge; 2018. The New Psychology of Health: Unlocking the Social Cure.

Hibbard J.H., Greene J., Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients' ‘scores’. Health Aff. 2013;32(2):216–222. PubMed

Hollander M., de Waard A.K.M. A survey of selective cardio-metabolic prevention programs in Europe. European Journal of Primary Care. 2019 In press. xx(xx): p. xx-xx.

Jetten J., Haslam C., Haslam A. Psychology Press; 2012. The Social Cure: Identity, Health and Well-being.

Jørgensen T. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. Br. Med. J. 2014;348:g3617. PubMed PMC

Jotterand F., Amodio A., Elger B.S. Patient education as empowerment and self-rebiasing. Med. Health Care Philos. 2016;19(4):553–561. PubMed

Kesteloot H., Sans S., Kromhout D. Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur. Heart J. 2005;27(1):107–113. PubMed

Klabunde C.N. Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults. Med. Care. 2005:939–944. PubMed

Kolor B. Patient education and treatment strategies implemented at a pharmacist-managed hepatitis C virus clinic. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2005;25(9):1230–1241. PubMed

Koopmans B. Non-participation in population-based disease prevention programs in general practice. BMC Public Health. 2012;12(1):856. PubMed PMC

Král N., de Waard A.K.M., Schellevis F.G., Korevaar J.C., Lionis C., Carlsson A.C., Larrabee Sonderlund A., Sondergaard J., Larsen L.B., Hollander M., Thilsing T., Angelaki A., de Wit N., Seifert B. What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group. European Journal of General Practice. 2019:1–8. PubMed PMC

Kringos D. The strength of primary care in Europe: an international comparative study. Br. J. Gen. Pract. 2013;63(616):e742–e750. PubMed PMC

Krska J., du Plessis R., Chellaswamy H. Views of practice managers and general practitioners on implementing NHS Health Checks. Primary Health Care Research & Development. 2016;17(2):198–205. PubMed

Larsen, L.B., Sondergaard, J., Thomsen, J. L., Halling, A., Sonderlund, A. L., Christensen, J. R., & Thilsing, T., Personal digital health profiles and attendance in a step-wise model to prevent chronic disease - a cross-sectional study of patient characteristics, health care usage, and uptake of a targeted intervention. Fam. Pract., (Under review).

Leese G.P. Screening uptake in a well-established diabetic retinopathy screening program: the role of geographical access and deprivation. Diabetes Care. 2008;31(11):2131–2135. PubMed PMC

Li G. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–1789. PubMed

Liang T.S. Rapid HIV testing of clients of a mobile STD/HIV clinic. AIDS Patient Care & STDs. 2005;19(4):253–257. PubMed

Lionis C., Angelaki A., Bertsias A. Final report on feasibility studies - SPIMEU deliverable 8.3. 2018. http://spimeu.org/wp-content/uploads/sites/8/2018/09/Deliverable-8.3-Report-of-the-feasibility-study-1.pdf

Mackenbach J.P. Socioeconomic inequalities in health in 22 European countries. N. Engl. J. Med. 2008;358(23):2468–2481. PubMed

Maibach E., Flora J.A., Nass C. Changes in self-efficacy and health behavior in response to a minimal contact community health campaign. Health Commun. 1991;3(1):1–15.

Michie S., Van Stralen M.M., West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement. Sci. 2011;6(1):42. PubMed PMC

Montano D.E., Kasprzyk D. Health Behavior: Theory, Research and Practice. 2015. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model; pp. 95–124.

Nielen M. An evidence-based cardiometabolic health check in general practice. Huisarts Wet. 2011;54:414–419.

OECD . 2017. Health at a Glance 2017.

Okechukwu C., Davison K., Emmons K. Social Epidemiology. 2014. Changing health behaviors in a social context; p. 365.

O'Malley A.S. After-hours access to primary care practices linked with lower emergency department use and less unmet medical need. Health Aff. 2012;32(1):175–183. PubMed

Peart A. Patient navigators facilitating access to primary care: a scoping review. BMJ Open. 2018;8(3) PubMed PMC

Rabbone I. Role of health care providers in educational training of patients with diabetes. Acta bio-medica: Atenei Parmensis. 2005;76:63–65. PubMed

Rimal R.N. Perceived risk and self-efficacy as motivators: understanding individuals' long-term use of health information. J. Commun. 2001;51(4):633–654.

Rosamond W. Heart disease and stroke statistics—2008 update. Circulation. 2008;117(4):e25–e146. PubMed

Unal B., Critchley J.A., Capewell S. Modelling the decline in coronary heart disease deaths in England and Wales, 1981–2000: comparing contributions from primary prevention and secondary prevention. Br. Med. J. 2005;331(7517):614. PubMed PMC

Van der Meer V. Cardiometabolic prevention consultation in the Netherlands: screening uptake and detection of cardiometabolic risk factors and diseases–a pilot study. BMC Fam. Pract. 2013;14(1):29. PubMed PMC

Voogdt-Pruis H.R. Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study. J. Adv. Nurs. 2011;67(8):1758–1766. PubMed

Wakefield M.A., Loken B., Hornik R.C. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261–1271. PubMed PMC

Wändell P.E. Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: a systematic review. Fam. Pract. 2018;35(4):383–398. PubMed

Wild S. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–1053. PubMed

World Health Organization . WHO Regional Office for Europe; Copenhagen, Denmark: 2017. Diabetes-data and Statistics.

World Health Organization . 2017. Cardiovascular Diseases (CVDs) Fact Sheet.

Yusuf S. Global burden of cardiovascular diseases: part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001;104(23):2855–2864. PubMed

Yusuf S. The World Heart Federation's vision for worldwide cardiovascular disease prevention. Lancet. 2015;386(9991):399–402. PubMed

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