Implementing selective-prevention primary care interventions targeting cardio-metabolic diseases in five European countries: the SPIM-EU project

Abstract

Background Cardio-metabolic diseases are the most common cause of death worldwide. Implementing selective prevention strategies has proven a substantial challenge, especially in primary care. Objectives As part of a collaborative European study, this paper aims to assess the implementation of primary care selective prevention interventions in the Czech Republic, Denmark, Greece, the Netherlands and Sweden. We sought to determine participants’ cardio-metabolic risk profile, as well as their evaluation of the intervention in terms of feasibility and impact in promoting a healthy lifestyle. Methods A selective prevention intervention, including patient invitation and cardio-vascular risk assessment using country-adjusted tools, was implemented. Eligible participants were primary care patients, 40–65 years of age, without any diagnosis of cardio-metabolic disease. Main outcomes included intervention acceptance and completion rates. Patient demographics, lifestyle-related cardio-metabolic risk factors, and opinions on intervention feasibility were recorded. Findings are summarized descriptively. Results In each country, 200 patients were invited to participate in the study. Acceptance rates varied from 19.5% (n = 39/200) in Sweden to 100% in the Czech Republic (n = 200/200). Risk assessment completion rates ranged from 65.4% (n = 70/107) in Greece to 100% (n = 39/39) in Sweden. Twelve individuals (6.9%) were identified as being at high risk of cardio-vascular disease in the Czech Republic, five (8.6%) in Denmark, eight (11.4%) in Greece, 21 (36.8%) in the Netherlands and none (0%) in Sweden. On a ten-point scale, the median (25%-75% quartile) of participant-reported intervention feasibility ranged from 7.4 (6.9–7.8) in Greece to 9.2 (8.2–9.9) in Sweden. Willingness to change lifestyle exceeded 80% in all countries, with the desire for better health representing the main motivating factor for more than half of the participants. Conclusions Although substantial variations in patient cardio-metabolic risk profile and intervention receptiveness were observed, our findings add to existing evidence regarding the implementation of selective prevention programs in European primary care and can be used as part of future cardio-metabolic risk reduction strategies.