An evidence-based toolbox for the design and implementation of selective-prevention primary-care initiatives targeting cardio-metabolic disease

Abstract

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.

Lifestyle counseling in patients with hypertension in primary health care and its association with antihypertensive pharmacotherapy

“…The Selective Prevention of Cardiometabolic Diseases Across Europe project (SPIMEU) proposed an evidence‐based toolbox with twelve recommendations to support the implementation of preventive initiatives, for example: the involvement of central stakeholders (e.g., policymakers and healthcare professionals) in the design of preventive initiatives, accommodate health professionals' existing workload and time constraints, and increase patient knowledge. 20 The implementation of these recommendations does however pose a challenge to primary care with the existing workload. Health checks and screenings have been suggested as an opportunity to implement lifestyle counseling.…”

“…in the design of preventive initiatives, accommodate health professionals' existing workload and time constraints, and increase patient knowledge. 20 The implementation of these recommendations does however pose a challenge to primary care with the existing workload.…”

Stepwise implementation of a cardiovascular risk management care program in primary care

“…In addition the our approach, a recent review from the SPIN-EU group came up with an evidence based generic “toolbox” for circumventing identified obstacles and harnessing facilitators in the design and implementation of cardiovascular prevention strategies. The development of the toolbox was based on data from five European countries, and may be of use in different communities, countries, and cultures [ 13 ].…”

Value-based Health Care Impact on Cardiovascular and Metabolic Diseases

“…4,5 PHC ensures cardiometabolic diseases are tracked, prevented and managed at a non-advanced stage or after an intervention in specialized care, and best practices for implementing specific programs have already been developed. 6 For PHC to perform its duty, however, it is important to encourage prevention, selfcare, and healthy habits, which can be done through remuneration models. 7 Remuneration strategies that include health outcome measures are required for implementing value-based healthcare 8 and, when it comes to PHC, it also refers to measuring whether prevention, tracking and education activities are being delivered to the assisted population in each unit.…”