Eligibility for interventions, co-occurrence and risk factors for unhealthy behaviours in patients consulting for routine primary care: results from the Pre-Empt study

Abstract

BackgroundSmoking, excessive drinking, lack of exercise and a poor diet remain key causes of premature morbidity and mortality globally, yet it is not clear what proportion of patients attending for routine primary care are eligible for interventions about these behaviours, the extent to which they co-occur within individuals, and which individuals are at greatest risk for multiple unhealthy behaviours. The aim of the trial was to examine ‘intervention eligibility’ and co-occurrence of the ‘big four’ risky health behaviours – lack of exercise, smoking, an unhealthy diet and excessive drinking – in a primary care population.MethodsData were collected from adult patients consulting routinely in general practice across South Wales as part of the Pre-Empt study; a cluster randomised controlled trial.After giving consent, participants completed screening instruments, which included the following to assess eligibility for an intervention based on set thresholds: AUDIT-C (for alcohol), HSI (for smoking), IPAQ (for exercise) and a subset of DINE (for diet). The intervention following screening was based on which combination of risky behaviours the patient had. Descriptive statistics, χ2 tests for association and ordinal regressions were undertaken.ResultsTwo thousand sixty seven patients were screened: mean age of 48.6 years, 61.9 % female and 42.8 % in a managerial or professional occupation. In terms of numbers of risky behaviours screened eligible for, two was the most common (43.6 %), with diet and exercise (27.2 %) being the most common combination. Insufficient exercise was the most common single risky behaviour (12.0 %). 21.8 % of patients would have been eligible for an intervention for three behaviours and 5.9 % for all four behaviours. Just 4.5 % of patients did not identify any risky behaviours. Women, older age groups and those in managerial or professional occupations were more likely to exhibit all four risky behaviours.ConclusionVery few patients consulting for routine primary care screen ineligible for interventions about common unhealthy behaviours, and most engage in more than one of the major common unhealthy behaviours. Clinicians should be particularly alert to opportunities to engaging younger, non professional men and those with multi-morbidity about risky health behaviour.Trial registrationISRCTN22495456

A systematic review on the clustering and co-occurrence of multiple risk behaviours

“…The main reason for study exclusion was the lack of investigation of co-occurrence or of clustering between risk behaviours. Thirty-seven studies [ 3 , 14 – 50 ] met the inclusion criteria and were included in the review.

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“…Twelve studies (thirteen datasets) assessed factors associated with engaging in multiple risk behaviours. Six included adult populations [ 3 , 14 , 15 , 21 , 46 , 50 ], three (four datasets) young adults [ 31 , 44 , 47 ], one students [ 36 ], one at risk populations [ 49 ] and one older adults [ 38 ].…”

“…Three used a cohort design [ 21 , 31 , 47 ] and nine a cross-sectional design [ 3 , 14 , 15 , 36 , 38 , 44 , 46 , 49 , 50 ]. Seven studies used an index of risk behaviours (e.g.…”

Rethinking brief interventions for alcohol in general practice

“…32 In a recent UK general practice trial, over 90% of patients who were identified as consuming too much alcohol also had a poor diet, did too little exercise, or smoked. 33 So, how, when, or why should practitioners with limited time prioritise alcohol over other potential targets for prevention? And would simultaneously addressing behavioural risks, if this could be arranged, be more or less effective than tackling them individually?…”

Lifestyle factors in somatic patients with and without potential alcohol problems

“…In most societies, professionals find it easier to address and offer helpful advice in relation all other unhealthy lifestyles except for alcohol abuse. People with alcohol problems often also present with other unhealthy lifestyles, and studies have shown that unhealthy lifestyle factors tend to cluster together (Randell et al 2015). Hence, using admission to the hospital coupled with a more generalized approach to asking patients about their alcohol consumption might help to identify individuals with harmful alcohol use and dependence.…”