Evaluation of a stepwise prevention program for cardiometabolic diseases in primary care

Abstract

In order to anticipate the increasing burden of disease of cardiometabolic diseases (CMD), such as cardiovascular disease, diabetes mellitus type 2 and chronic kidney damage, the Dutch College of General Practitioners developed the guideline 'Prevention Consultation' in 2011, a stepwise prevention program for CMD in general practice. In this thesis, the different aspects of the 'Prevention Consultation' are evaluated using the RE-AIM model (reach, effectiveness, acceptance, implementation and maintenance), with a specific focus on the reach, effectiveness and implementation of the prevention program. We implemented the prevention program in 37 general practices in the Netherlands and compared the program with care-as-usual. The reach of the prevention program is limited and participation is not equally distributed amongst different demographic and socio-economic groups, resulting in an under-representation of socially vulnerable groups among participants. Response-enhancing strategies, including those targeting socially vulnerable groups, only have a limited effect. The implementation of the prevention program is feasible and effective in short term, with a positive effect on newly detected CMD and on the systolic blood pressure and cholesterol levels. Practice organization and available lifestyle programs are not associated with effectiveness of the program. The program shows no effect on motivation to change lifestyle. Furthermore, the prevention program is not cost-effective in terms of long-term health benefits (see twinned thesis Stol). We conclude that a broad implementation of the "Prevention Consultation" in the Netherlands is not recommended. Opportunistic screening for CMD in general practice remains important, as well as a greater commitment to universal prevention.