In the Netherlands, approximately 1.6 million people have cardiovascular disease and approximately 1.2 million people have diabetes
The short-term effects of a prevention program via general practitioners to prevent cardiovascular disease and diabetes are positive, but the (cost) effectiveness in the long term is lacking, according to research. Monika Hollander, general practitioner for cardiovascular diseases and assistant professor at UMC Utrecht, sees 40+ consultancies as a better alternative.
On 22 September, Ilse Badenbroek and Daphne Stol obtained their PhD with their duo research into the (cost) effectiveness of a step-by-step prevention program via general practitioners to prevent cardiovascular diseases and diabetes (cardiometabolic diseases). Ilse evaluated the step-by-step prevention program. Daphne’s linked thesis describes the (cost) effectiveness of this selective prevention. The research showed that the prevention program is effective in the short term. For example, more new patients were identified and after one year of follow-up, the participants in the study had lower blood pressure and more favorable cholesterol levels. However, in the long term, the efforts have not been found to be cost effective, as only a small proportion of people have completed the program to reduce risk factors.
Effects of lifestyle advice low
For Monika, who is involved as co-promoter in this large duo study, 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 that we would achieve better results in the longer term. We saw the greatest effect in people with a greatly increased risk, who had been treated with drugs to lower blood pressure or cholesterol. But in most people the risk was not so increased and lifestyle advice was advised. Only a small part of the people have followed up on this. Partly as a result of this, the long-term effects of the prevention consultation were not high. Lifestyle improvement is very difficult to achieve only through the doctor. This requires a broad approach close to the people. ”
Shared social task
Monika considers prevention of diseases and commitment to lifestyle improvement a shared social task. “As GPs, we cannot do this alone. We can advise people, but if unhealthy food is frequently available for a low price and there is no structural information and guidance, then we are fighting a losing battle. Moreover, it was discussed during the Woudschoten conference last year that population prevention is not part of the GP’s duties. Of course it is when treatment is needed, but not in the preceding phase. There must be a joint vision and a well-embedded approach regarding the prevention of cardiovascular diseases and the lifestyle improvement of GPs together with the zero line and second line. Think of schools, local government, social workers, district nurses, physiotherapists, et cetera. ”
40+ clinic
As a solution, Monika is thinking in the direction of a 40+ consultation office, 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. ”
Heart disease and diabetes
In the Netherlands, approximately 1.6 million people have cardiovascular disease and approximately 1.2 million people have diabetes (source: Ministry of Health, Welfare and Sport). Prevention could prevent as much as eighty percent of cardiovascular disease and diabetes. In 2011, the Dutch General Practitioners Association developed the guideline ‘The Prevention Consultation’ for people between the ages of 45 and 70 who are not yet familiar with cardiovascular disease and / or diabetes and / or the risk factors for this. Until now, scientific evidence was lacking for the (cost) effectiveness of the approach.
Ilse and Daphne’s doctoral research into the (cost) effectiveness of a step-by-step prevention program through general practitioners took place through nearly 40 general practices in the Netherlands in collaboration with Nivel and Niped. The research 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.
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