Cardiovascular disease prevention consultation not cost-effective
The short-term effects of a prevention program via general practitioners to prevent cardiovascular disease and diabetes are positive, but the long-term cost-effectiveness remains unlikely, according to research by UMC Utrecht.
In the Netherlands, approximately 1.6 million people have cardiovascular disease and 1.1 million people have type 2 diabetes. Prevention could prevent as much as eighty percent of cardiovascular diseases and cases of type 2 diabetes. In 2011 the Dutch College of General Practitioners developed the guideline ‘The Prevention Consultation’. All patients between 45 and 70 years old from practice are invited to take a risk test to map out their risk factors in the field of cardiovascular disease and type 2 diabetes. Even if patients have no complaints yet. Depending on the outcome of the risk test, patients receive an invitation for a prevention consultation and a counseling process starts in which the general practitioner looks at medication and lifestyle.
Difficult to adjust lifestyle
Ilse Badenbroek and Daphne Stol conducted duo research into the (cost) effectiveness of this prevention program. More than 12,000 patients from nearly forty GP practices in the Netherlands participated in the study. The research showed that the prevention program is effective in the short term. In the first year, for example, more new patients were identified with high blood pressure, high cholesterol and type 2 diabetes, and the study participants had a lower blood pressure, more favorable cholesterol levels and the waist circumference after one year. However, in the long term, a small proportion of patients appeared to complete the full program. Structurally changing aspects of lifestyle such as quitting smoking, losing weight and exercising more proved difficult. The guidance from the GP during such a process is very labor-intensive, so that the costs do not outweigh the long-term effects for patients.
More attention to lifestyle
The prevention consultation is therefore effective for detecting patients with unknown complaints and risk factors, but long-term guidance requires more than just guidance by the general practitioner. The research shows that better information and communication about a healthy lifestyle, which also takes into account the socio-cultural background of patients, can contribute to a greater health effect in the long term.
Cooperation
Ilse and Daphne’s doctoral research into the (cost) effectiveness of a step-by-step prevention program via general practitioners was carried out in collaboration with Nivel and Niped. The research took approximately seven years and was funded by ZonMW, the Lekker Lang Leven consortium (consisting of the Diabetes Fund, the Heart Foundation and the Kidney Foundation) and the Healthcare Insurers Innovation Fund.
40+ clinic
Monika Hollander, general practitioner for cardiovascular diseases and assistant professor at UMC Utrecht, sees 40+ consultation offices as a better alternative. Focused on prevention and lifestyle intervention, financed by health insurers. “A regular check-up has been arranged for babies and young children, but that suddenly stops. Why don’t we make this possible for people around forty years and older as well? ” 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 – coaching in a team to realize lifestyle changes. For example together with psychologists, dieticians and physiotherapists. In this way we remove the partitions between the zero, first and second lines and we ensure that there is sufficient time for mutual consultation. With such an approach we can really achieve something in the prevention of cardiovascular disease and diabetes and thus prevent a lot of misery. ”
Read more about her vision here: https://www.umcutrecht.nl/nieuws/40-consultatiebureau-tegen-hart-en-vaatziekte
Source: UMC Utrecht
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