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Self-reported cognitive and emotional effects and lifestyle changes shortly after preventive cardiovascular consultations in general practice Dea Kehler. Department of General Practice. Research Unit for General Practice U N I V E R S I T Y OF A A R H U S . Outline. Background Aim

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slide1

Self-reported cognitive and emotional effects and lifestyle changes shortly after preventive cardiovascular consultations in general practice Dea Kehler

Department of General Practice

Research Unit for General Practice

U N I V E R S I T Y OF A A R H U S

outline
Outline
  • Background
  • Aim
  • Design
  • Material
  • Method
  • Results
  • Strenghts and weaknesses
  • Conclusion
  • Perspectives
  • Future research
background
Background
  • It is evidence based that lifestyle interventions is effectfull in prevention of CVD
  • It is a fact that many patients with high risk of CVD do not obtain the treatment goals in daily clinic
  • The adherence to lifestyle counselling and medication is not optimal either from the GP or patient perspective
background4
Background
  • In Denmark and many other countries, prevention of disease has become a priority area in recent years
  • Prevention of CVD has been a focus area in general practice in Denmark since 1999
background5
Background

In 2006, a scheduled preventive consultation for people at increased risk of CVD was introduced together with a set of clinical guidelines, published by the Danish College of General Practitioners.

clinical guidelines
Clinical guidelines
  • To estimate the total cardiovascular risk from fatal CVD within 10 years by using the score system and use the recommendations addressing the specific risk
  • To identify components of risk that are to be modified and patients’ own perception of the issue
  • To use motivational interviewing and adopted risk handling strategies based on shared decision making
  • To schedule a follow-up consultation
slide7
Number of preventive cardiovascular consultations (1999-2006) and preventive consultations in all (2006-2008) in DK
slide8
Aims

To explore og analyse GPs and patients experiences with:

1.1 Communication about motivation in relation to lifestyle

changes through a mixed approach

1.2. The doctor-patient relationship in relation to lifestyle changes

through a mixed approach

1.3. Risk commmuncation through a mixed approach

1.4 To quantify and analyse patients evaluations of preventive consultations through a questionnaire study

questionnaire aim
Questionnaire aim

To describe patients’ evaluation of the contents of preventive

cardiovascular consultations and to analyse whether their

evaluation is shaped by self-reported cognitive and emotional

effects and lifestyle change two to six weeks after the consultations

questionnaire material
Questionnaire material

The health insurance register provided data on 2450 people, who had a preventive cardiovascular consultation in february 2007

1714 filled out a consultation evaluation questionnaire 2 to 6 weeks after their preventive consultation with their GP (70%)

Among these, 1226 fulfilled the inclusion criteria, which were:

  • Participation in a scheduled preventive consultation with focus on primary prevention of CVD and an individual risk assessment
  • To be at 5% or higher risk of fatal (death) CVD within 10 years by using the Score system without earlier identified CVD
questionnaire sections
Questionnaire sections
  • Section 1

Questions related to patient, GP and consultation characteristics

and demographic information validated by DIKE and SF12

  • Section 2

Questions related to the consultation content and effects

developed from qualitative consultation and interview studies

with patients at cardiovascular risk and their GPs

  • Section 3

Comprised two items from COMRADE, a validated patient

questionnaire to evaluate risk communication and decision

making effectiveness in general practice.

the analysis
The analysis
  • The exposure and outcome variables were dichotomized in order to analyse the data and create sum scores
  • Data cleaning and variabel modification
  • Generation of frequency analysis and histograms
  • Regression analysis

Crude odds ratios

Adjusted odds ratios (confounder adjusted)

  • Effect modification analysis (Wald test)
results
Results

Slightly more men than women

Mean age 61 years (range 22-89)

Most patients were married

70.2 % short-term education

1-2 risk factors: 36%

3-4 risk factors: 41%

4-5 risk factors: 23%

results14
Results

Patients reported cognitive effects 2-6 weeks after

participation in a preventive consultation in the form of:

  • Increased knowledge about health (79%)
  • Increased focus on health and CVD (61%)
  • Better overview in relation to own health (63%)
  • Increased ability to see how lifestyle influence on health (58%).
results15
Results

Patients reported changes in lifestyle habits 2 to 6 weeks

after participation in a preventive consultation:

  • Eating habits (57%)
  • Physical activity habits (48%)
  • Smoking habits (22%)
results16
Results

Patients reported emotional effects 2 to 6 weeks after

participation in a preventive consultation in the form of:

  • Relief (80%)
  • Consultation satisfaction (97%)
  • Concerns (23%)
r esults
Results

Patients, who communicated with their GP about:

  • Cardiovascular risk
  • Daily living and lifestyle habits
  • Knowledge about CVD
  • Perception of cardiovascular risk
  • Own preventive possibilities

reported significant more frequent 3 or 4 cognitive benefits, one or several changes in lifestyle habits and were more frequent satisfied after participation in a preventive cardiovascular consultation (OR range 1.74-4.27)

results18
Results

Patients reporting being informed about risk of disease or that

lifestyle habits had been addressed during the consultation were

significantly less frequently relieved, than patients who rapported

that these issues had not been raised (OR 0.3-0.7)

results19
Results

Patients, who reported that issues as:

  • Daily living
  • Own perception of risk
  • Knowledge about CVD
  • Own preventive possibilities

had been raised in the consultation, were significantly

more often relieved (OR range 1.61–2.50) than

patients, where the issues had not being raised

results20
Results

Patients reported that issues as:

Information about risk

Daily living and lifestyle habits

Own perception of cardiovascular risk

Knowledge about CVD

Own preventive possibilities

were significantly more often satisfied with the

consultation than those, who had not.

(OR range 2.2-8.3)

results21
Results

In all, there was no significant difference between crude and

adjusted ORs and introduction of interactions in the regression

models did not significantly change any of the ORs.

questionnaire weaknesses
Cross-sectional study – no conclusions about causalities

No long-term effects of the preventive consultation

No statistical or psychometric validation of the deveoloped questionnaire during factor or correlation analysis

The study may be hampered by recall bias, selections bias and confouding

Questionnaire weaknesses
questionnaire strenghts
The response rate was 70%

Quite narrow confidence intervals

High face and content validity

Good generalisability national related to the non-restrictive inclusion and the construction of the questionnaire

GP independent inclusion of patients

Questionnaire strenghts
conclusion
Conclusion

Cardiovascular risk patients reported cognitive and emotional

effects and healthy lifestyle changes 2-6 weeks after a preventive

consultation and increase in the effects and their consultation

satisfaction, if the following issues were raised during the consultation:

  • Cardiovascular risk
  • Patients daily living and lifestyle habits
  • Knowledge about health and cardiovascular disease
  • Own perception of cardiovascular risk
  • Own preventive possibilities
perspectives
Perspectives

The questionnaire study has shown that the preventive

consultation has a development potential, which can be

used in medical education programmes based on

professional, communicative and lifestyle changing

competence elements in the future

perspectives26
Perspectives

When the education program is developed, it could be interesting

to investigate, whether patients have more benefits of the

preventive consultations on the long run than by participating

in the actual preventive consultation in general practice

perspectives27
The results can be used in the future development and political

debate about primary prevention and preventive consultations in

general practice

The results underline that the consultation and its content is

important in succesfull primary prevention of CVD

Perspectives
future research
Future research

To investigate whether patiens reported cognitive and emotional effects and

healthy changes in life habits rest over time

To investigate and identify the consultation elements, which have the most

significant impact on patient reported effects of preventive consultations

To investigate how many and which type of patients, who need preventive

consultations to change and maintain healthy lifestyle changes

To investigate whether motivational interviewing and adopted risk handling

strategies based on shared decision making could help the GPs and the

patients to verbalise and solve the existing ambivalence in preventive

consultations

acknowledgements
Acknowledgements
  • Participating GPs and patients
  • The health insurance registers
  • The Danish Agency of science