The short-term effects of a prevention program through general practitioners to prevent cardiovascular disease and diabetes are positive, but long-term (cost) effectiveness is lacking, research shows. Monika Hollander, senior physician in cardiovascular diseases and assistant professor at UMC Utrecht, sees 40+ consultancies as a better alternative.
Sept. 22, Ilse Badenbroek and Daphne Stol received their PhD with their duo research on the (cost) effectiveness of a step-by-step prevention program via general practitioners to prevent cardiovascular disease and diabetes (cardiometabolic diseases). Ilse evaluated the stepwise prevention program. Daphne’s linked dissertation describes the (cost) effectiveness of this selective prevention. The study showed that the prevention program is effective in the short term. For example, more new patients were detected, and after one year of follow-up, study participants had lower blood pressure and more favorable cholesterol levels. However, in the long term, the efforts were not found to be cost-effective, as only a small proportion of people completed the program entirely to reduce risk factors.
For Monika, who was involved in this large duo study as co-promoter, these results are somewhat disappointing. “Before the study, we had our doubts about the feasibility of this prevention approach in general practice, as it is very labor-intensive, but we had hoped for better results in the longer term. We saw the most effect in people at high risk, where there had been drug treatment to lower blood pressure or cholesterol. But in most people the risk was not so elevated and lifestyle advice was advised. Only a small proportion of people followed up. Partly as a result, the long-term effects of the prevention consultation were not high. Lifestyle improvement is very difficult to achieve through the general practitioner alone. That requires a broad approach close to the people.”
Monika considers disease prevention and commitment to lifestyle improvement a shared social task. “We as general practitioners cannot do that alone. We can advise people, but if unhealthy food is frequently available at a low price and there is no structural information and guidance, then it’s fighting against a losing battle. Moreover, just last year it was discussed at the Woudschoten conference that population prevention does not belong in the GP’s remit. Of course it does if treatment is needed, but not in the phase before. There must be a shared vision and well embedded approach around prevention of cardiovascular disease and lifestyle improvement by general practitioners together with the zero line and second line. Think schools, local government, social workers, district nurses, physical therapists, et cetera.”
As a solution, Monika thinks in the direction of a 40+ consultation bureau, focused on prevention and lifestyle intervention, funded by health insurance companies. “For babies and young children a regular check-up is arranged, but suddenly that stops. Why not also make this possible for people around 40 and older?” A regular check-up in the neighborhood, so close to the people, with a weight measurement, blood pressure measurement, cholesterol check, et cetera. And from there, if necessary, in the neighborhood – so close to the people – in team counseling to realize lifestyle changes. For example, together with psychologists, dieticians and physiotherapists. In this way we remove the barriers between the first, second and third lines and ensure that there is sufficient time for mutual consultation. With such an approach we can really achieve something in preventing cardiovascular disease and diabetes and thus prevent a lot of misery.”
In the Netherlands, about 1.6 million people have cardiovascular diseases and about 1.2 million people have diabetes (source: Ministry of Public Health Welfare and Sport). Through prevention, as many as eighty percent of cardiovascular diseases and diabetes cases could be prevented. In 2011, the Nederlands Huisartsen Genootschap developed the guideline “The Prevention Consultation” for people between the ages of 45 and 70 who are not yet familiar with cardiovascular diseases and/or diabetes and/or the risk factors for these. Until now, scientific evidence was lacking for the (cost) effectiveness of the approach.
Ilse and Daphne’s PhD research into the (cost) effectiveness of a step-by-step prevention program through general practitioners took place through almost forty general practitioner practices in the Netherlands in collaboration with Nivel and Niped. The research was funded by ZonMW, the consortium Lekker Lang Leven (consisting of the Diabetes Fund, the Heart Foundation and the Kidney Foundation) and the Innovatiefonds Zorgverzekeraars.
