Screening for increased cardiometabolic risk in primary care: a systematic review

Engelsen, Corine den; Koekkoek, Paula S.; Godefrooij, Merijn; Spigt, Mark; Rutten, Guy E.H.M.

doi:10.3399/bjgp14x681781

Cited by 25 publications

(27 citation statements)

References 25 publications

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“…To the best of our knowledge, there has previously been no systematic review analyzing the effectiveness of interventions used to increase uptake rate of CVD risk factors screening amongst the general population from primary care practices and the community. Previous systematic reviews have focused on assessing the effectiveness of using community pharmacies as the site for CVD risk factors screening [29], the evaluation of behavioural components used in the intervention of screening programmes [30], and reviewing screening approaches in primary care [31]. Therefore, the objective of this study is to examine the literature to determine the effectiveness of interventions used to increase the uptake of CVD risk factors screening in adult population from primary care practices and the community.…”

Section: Introductionmentioning

confidence: 99%

Are interventions to increase the uptake of screening for cardiovascular disease risk factors effective? A systematic review and meta-analysis

et al. 2017

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BackgroundCardiovascular disease (CVD) is the leading cause of death globally. However, many individuals are unaware of their CVD risk factors. The objective of this systematic review is to determine the effectiveness of existing intervention strategies to increase uptake of CVD risk factors screening.MethodsA systematic search was conducted through Pubmed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials. Additional articles were located through cross-checking of the references list and bibliography citations of the included studies and previous review papers. We included intervention studies with controlled or baseline comparison groups that were conducted in primary care practices or the community, targeted at adult populations (randomized controlled trials, non-randomized trials with controlled groups and pre- and post-intervention studies). The interventions were targeted either at individuals, communities, health care professionals or the health-care system. The main outcome of interest was the relative risk (RR) of screening uptake rates due to the intervention.ResultsWe included 21 studies in the meta-analysis. The risk of bias for randomization was low to medium in the randomized controlled trials, except for one, and high in the non-randomized trials. Two analyses were performed; optimistic (using the highest effect sizes) and pessimistic (using the lowest effect sizes). Overall, interventions were shown to increase the uptake of screening for CVD risk factors (RR 1.443; 95% CI 1.264 to 1.648 for pessimistic analysis and RR 1.680; 95% CI 1.420 to 1.988 for optimistic analysis). Effective interventions that increased screening participation included: use of physician reminders (RR ranged between 1.392; 95% CI 1.192 to 1.625, and 1.471; 95% CI 1.304 to 1.660), use of dedicated personnel (RR ranged between 1.510; 95% CI 1.014 to 2.247, and 2.536; 95% CI 1.297 to 4.960) and provision of financial incentives for screening (RR 1.462; 95% CI 1.068 to 2.000). Meta-regression analysis showed that the effect of CVD risk factors screening uptake was not associated with study design, types of population nor types of interventions.ConclusionsInterventions using physician reminders, using dedicated personnel to deliver screening, and provision of financial incentives were found to be effective in increasing CVD risk factors screening uptake.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0579-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Are interventions to increase the uptake of screening for cardiovascular disease risk factors effective? A systematic review and meta-analysis

et al. 2017

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“…Stepwise screening methods-such as in the Dutch CMD detection program-are preferred, selecting people at high risk-who are likely to benefit most from interventions-reducing the number of people that needs to be screened. 27 In addition, previous studies have shown that this stepwise program is positively evaluated by GPs and patients. 28,29 To further optimize acceptance, compliance and participation rates of the program, additional analyses of nonresponse and response-enhancing strategies are warranted.…”

Section: Implications For Research and Practicementioning

confidence: 97%

Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

Stol

Hollander

Badenbroek

et al. 2019

European Journal of Public Health

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Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

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“…This con rms our nding that it is important to involve HPs in forthcoming preventive initiatives in order to facilitate participation. Similarly, a review suggested that involving GPs might facilitate screening e ciency and uptake (38). The AASAP approach may also reduce the likelihood that individuals with T2D experience diabetes-related stigma when HPs discuss the potential relevance of participating in preventive initiatives.…”

Section: Improving the Basis For Increasing Participation In Preventimentioning

confidence: 99%

Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

Dahl

Soendergaard

Diederichsen

et al. 2020

Preprint

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Background Type 2 diabetes (T2D) is associated with a significant increased risk of cardiovascular disease (CVD). The DIAabetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40–60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting prevention of CVD. Methods We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40–60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis. Results The participants’ experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from proactive to reactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in forthcoming preventive initiatives. Conclusion Encouraging people with T2D to participate in cardiovascular preventive initiatives might necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees’ characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular disease prevention. Our proposed model may be applicable in preventive services for people with T2D in general.

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Screening for increased cardiometabolic risk in primary care: a systematic review

Cited by 25 publications

References 25 publications

Are interventions to increase the uptake of screening for cardiovascular disease risk factors effective? A systematic review and meta-analysis

Are interventions to increase the uptake of screening for cardiovascular disease risk factors effective? A systematic review and meta-analysis

Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

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