What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group

Abstract

Background: Selective prevention of cardiometabolic diseases (CMD)—that is, preventive measures specifically targeting the high-risk population—may represent the most effective approach for mitigating rising CMD rates. Objectives: To develop a universal concept of selective CMD prevention that can guide implementation within European primary care. Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round. Results: In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated. Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.

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

“…Our WP D consensus meeting discussions arrived at two recommendations for the definition of the high-risk population (Kral et al, In press):Age range: The target population should include (but not necessarily be limited to) people between 40 and 70 years old. Current evidence that shows that this age bracket is most likely to be at increased risk of CMDs, and also most likely to respond positively to preventive efforts.Pre-existing conditions: By definition, the high-risk population for CMD-SPIs does not include people who have been diagnosed with a CMD.For optimum accuracy and validity, locally validated risk-assessment tools will likely yield the best results in terms identifying the target population.At our consensus meeting, there was unanimous agreement that CMD-risk assessment should be conducted by use of locally validated measures (Kral et al, In press). This recommendation was based on the presumably greater efficacy of local measures in terms of accuracy, reliability, and cultural appropriateness.…”

“…We then investigated the barriers and facilitators of patient (de Waard et al, 2018a) and GP (de Waard et al, 2018b; Wändell et al, 2018) attitudes to selective prevention of CMD (WP B & C, respectively). In WP D and E, we developed (Kral et al, In press) and feasibility tested (Lionis et al, 2018) a generic CMD-SPI in the five partner countries.…”

“…The factors that predict non-participation vary across countries. CMD-SPIs should therefore be tailored to local settings and context.DDevelopment of practical, step-wise implementation method for SPIs (Kral et al, In press). Design : RAND/UCLA appropriateness method a.…”

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

“…The design and critical determinants of the selective prevention intervention were informed by a consensus meeting with an international panel of 14 experts exploring the evidence from systematic literature reviews and surveys conducted within SPIM-EU (11). The present selective prevention intervention included the invitation and CVD-risk assessment of primary care patients and was implemented in the Czech Republic, Denmark, Greece, the Netherlands and Sweden.…”

“…SPIM-EU seeks to contribute to the reduction of CMD morbidity and mortality in Europe by testing the feasibility of evidence-based selective prevention strategies and providing comprehensive tools for their application in primary care (10). Within the framework of SPIM-EU an expert consensus meeting has been conducted and a set of statements representing the key characteristics of selective CMD prevention has been proposed in order to develop a universal concept of selective CMD prevention that can guide implementation within European primary care (11). The overall aim of the present study was to assess the feasibility of CMD selective prevention in five considerably different European primary care settings (Czech Republic, Denmark, Greece, Netherlands and Sweden), with special focus on patient participation and acceptance rates.…”