More attention required for life-style interventions in general practice

In the Netherlands, approximately 1.6 million people suffer from cardiovascular disease, while 1.1 million people have type 2 diabetes. Prevention could reduce the incidence of cardiovascular diseases and type 2 diabetes cases by as much as eighty percent. In 2011, the Dutch College of General Practitioners developed the "Prevention Consultation". All patients aged between 45 and 70 in general practice are invited to have a risk test performed to identify their risk factors for cardiovascular disease and type 2 diabetes. Even if the patients have no complaints. Depending on the outcome of the risk test, patients are invited to a Prevention Consultation and a counseling process is started in which their GP looks at medication and lifestyle.

Difficult to change lifestyle
Ilse Badenbroek and Daphne Stol conducted a dual study into the (cost) effectiveness of the prevention program. Over 12,000 patients from almost 40 general practices in the Netherlands participated in the study. The study has shown that the prevention program is effective in the short term. In the first year, more new patients with high blood pressure, high cholesterol and type 2 diabetes were found; after a year they had a lower blood pressure, more favorable cholesterol levels, and their waist circumference had decreased. However, it turned out in the long term that only a small part of the patients completed the entire program. It proved difficult to change lifestyle aspects such as quitting smoking, dieting and exercising for the longer term. Counseling by general practitioners in this process is very labor-intensive, which means that the costs do not outweigh the long-term effects in patients.

More attention to lifestyle
So while the prevention consultation is effective for detecting patients with unknown complaints and risk factors, long-term counseling requires more than just guidance by the general practitioner. Research has shown that better information and communication about a healthy lifestyle, which also takes the sociocultural background of patients into account, can contribute to a greater health effect in the long term.

Ilse and Daphne's doctoral research into the (cost) effectiveness of a step-by-step prevention program through general practitioners was carried out in collaboration with Nivel and Niped. The study lasted some seven years and was financed by the Netherlands Organisation for Healthcare Research and Development, the Lekker Lang Leven consortium (consisting of the Diabetes Fund, the Dutch Heart Foundation and the Kidney Foundation) and the Innovatiefonds Zorgverzekeraars.   

40+ health center
Monika Hollander, general practitioner specialized in cardiovascular diseases and assistant professor at UMC Utrecht, considers 40+ health centers to be a better alternative. Aimed at prevention and lifestyle intervention, financed by healthcare insurers. “Arrangements for regular check-ups are in place for babies and young children but these suddenly stop. Why don't we also make this possible for people in their forties and older?" A regular check-up in the community, so close to the people, with a weight measurement, blood pressure measurement, cholesterol check, etcetera. And from there, if necessary, team supervision in the community, i.e. close to the people, to bring about lifestyle changes. For example, together with psychologists, dieticians and physiotherapists. The partitions between preventive, primary and secondary healthcare are easy to remove and we will make sure there is enough time for mutual consultation. Such an approach really allows us to achieve something in preventing cardiovascular disease and diabetes and hence prevent a lot of misery.”
Read more about her vision here: (article in Dutch)