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Smits GHJM, van Doorn S, Bots ML, Hollander M. Patient characteristics and reasons for discontinuation in a cardiovascular risk management programme in The Netherlands. BMC PRIMARY CARE 2024; 25:55. [PMID: 38342918 PMCID: PMC10860257 DOI: 10.1186/s12875-024-02293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Since 2010, an increasing number of patients have participated in a nurse-led integrated cardiovascular risk management programme in the Netherlands. Because it is important to understand which patients discontinue and why, when evaluating the effectiveness of the care programme, the aim was to identify the reasons for discontinuation. METHODS Electronic health records of 3997 patients enrolled in a nurse-led integrated cardiovascular risk management programme that started on April 1st, 2010, were manually scrutinized for reasons for discontinuation between April 1st, 2010, and April 1st, 2018. In addition to death and moving to a diabetes care programme, we describe 7 different reasons why patients discontinued the programme and compared the patient characteristics of those who discontinued the programme without specific reasons with those who remained in the care programme for 8 years. RESULTS Between April 1st, 2010, and April 1st, 2018, 1,190 participants (29.8%) discontinued the CVRM care programme, of whom 271 participants died (6.8%) and 195 were transferred to a diabetes care programme (4.9%). The remaining 724 patients (18.1%) participated 5 years before discontinuation. Of these, 67 (9.3%) had a previous cardiovascular event at the start of the programme. In 355 patients, a specific reason for discontinuation was not found. At baseline, these patients less frequently had a history of CVD than those who continued the programme for 8 years (1.7 vs. 22.6%), were younger (62 vs. 67 years), had less registered cardiovascular comorbidity (atrial fibrillation: 1.1 vs. 7.2%; congestive heart failure 0.3 vs. 1.2%; chronic kidney disease 0.0 vs. 4.5%), were more often smokers (13.0% vs. 4.3%) and took blood pressure- and lipid-lowering drugs twice as often. CONCLUSIONS In our study we observed that participants who discontinued the nurse-led integrated CVRM care programme between 2010 and 2018 without specific reason or on request were younger, without previous CVD, had less cardiovascular comorbidity and were better adjusted to medication. Exploring the patients' reasons for discontinuation can contribute to an individualized approach to prevent or reduce discontinuation.
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Affiliation(s)
- Geert H J M Smits
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Primary Care Group PoZoB, Bolwerk 10-14, Veldhoven, 5509 MH, The Netherlands.
| | - Sander van Doorn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Nieuwenhuijse EA, Vos RC, van den Hout WB, Struijs JN, Verkleij SM, Busch K, Numans ME, Bonten TN. The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5040. [PMID: 36981949 PMCID: PMC10048996 DOI: 10.3390/ijerph20065040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/04/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and cost-effectiveness of offering the combined lifestyle programme "Healthy Heart", addressing overweight, diet, physical activity, smoking and alcohol, to improve lifestyle behaviour and reduce cardiovascular risk. DESIGN A practice-based non-randomised stepped-wedge cluster trial with two-year follow-up. Outcomes were obtained via questionnaires and routine care data. A cost-utility analysis was performed. During the intervention period, "Healthy Heart" was offered during regular cardiovascular risk management consultations in primary care in The Hague, The Netherlands. The period prior to the intervention period served as the control period. RESULTS In total, 511 participants (control) and 276 (intervention) with a high cardiovascular risk were included (overall mean ± SD age 65.0 ± 9.6; women: 56%). During the intervention period, 40 persons (15%) participated in the Healthy Heart programme. Adjusted outcomes did not differ between the control and intervention period after 3-6 months and 12-24 months. Intervention versus control (95% CI) 3-6 months: weight: β -0.5 (-1.08-0.05); SBP β 0.15 (-2.70-2.99); LDL-cholesterol β 0.07 (-0.22-0.35); HDL-cholesterol β -0.03 (-0.10-0.05); physical activity β 38 (-97-171); diet β 0.95 (-0.93-2.83); alcohol OR 0.81 (0.44-1.49); quit smoking OR 2.54 (0.45-14.24). Results were similar for 12-24 months. Mean QALYs and mean costs of cardiovascular care were comparable over the full study period (mean difference (95% CI) QALYs: -0.10 (-0.20; 0.002); costs: EUR 106 (-80; 293)). CONCLUSIONS For both the shorter (3-6 months) and longer term (12-24 months), offering the Healthy Heart programme to high-cardiovascular-risk patients did not improve their lifestyle behaviour nor cardiovascular risk and was not cost-effective on a population level.
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Affiliation(s)
- Emma A. Nieuwenhuijse
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Rimke C. Vos
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Wilbert B. van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jeroen N. Struijs
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment, 3720 MA Bilthoven, The Netherlands
| | - Sanne M. Verkleij
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Karin Busch
- Hadoks Chronische Zorg BV, 2517 JK The Hague, The Netherlands
| | - Mattijs E. Numans
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Tobias N. Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Czwikla J, Herzberg A, Kapp S, Kloep S, Rothgang H, Nitschke I, Haffner C, Hoffmann F. Generalizability and reach of a randomized controlled trial to improve oral health among home care recipients: comparing participants and nonparticipants at baseline and during follow-up. Trials 2022; 23:560. [PMID: 35804423 PMCID: PMC9264743 DOI: 10.1186/s13063-022-06470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The generalizability of randomized controlled trials (RCTs) with a low response can be limited by systematic differences between participants and nonparticipants. This participation bias, however, is rarely investigated because data on nonparticipants is usually not available. The purpose of this article is to compare all participants and nonparticipants of a RCT to improve oral health among home care recipients at baseline and during follow-up using claims data. Methods Seven German statutory health and long-term care insurance funds invited 9656 home care recipients to participate in the RCT MundPflege. Claims data for all participants (n = 527, 5.5% response) and nonparticipants (n = 9129) were analyzed. Associations between trial participation and sex, age, care dependency, number of Elixhauser diseases, and dementia, as well as nursing, medical, and dental care utilization at baseline, were investigated using multivariable logistic regression. Associations between trial participation and the probability of (a) moving into a nursing home, (b) being hospitalized, and (c) death during 1 year of follow-up were examined via Cox proportional hazards regressions, controlling for baseline variables. Results At baseline, trial participation was positively associated with male sex (odds ratio 1.29 [95% confidence interval 1.08–1.54]), high (vs. low 1.46 [1.15–1.86]) care dependency, receiving occasional in-kind benefits to relieve caring relatives (1.45 [1.15–1.84]), having a referral by a general practitioner to a medical specialist (1.62 [1.21–2.18]), and dental care utilization (2.02 [1.67–2.45]). It was negatively associated with being 75–84 (vs. < 60 0.67 [0.50–0.90]) and 85 + (0.50 [0.37–0.69]) years old. For morbidity, hospitalizations, and formal, respite, short-term, and day or night care, no associations were found. During follow-up, participants were less likely to move into a nursing home than nonparticipants (hazard ratio 0.50 [0.32–0.79]). For hospitalizations and mortality, no associations were found. Conclusions For half of the comparisons, differences between participants and nonparticipants were observed. The RCT’s generalizability is limited, but to a smaller extent than one would expect because of the low response. Routine data provide a valuable source for investigating potential differences between trial participants and nonparticipants, which might be used by future RCTs to evaluate the generalizability of their findings. Trial registration German Clinical Trials Register DRKS00013517. Retrospectively registered on June 11, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06470-y.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany. .,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany. .,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Alexandra Herzberg
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Sonja Kapp
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.,Competence Center for Clinical Trials, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Ina Nitschke
- Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, University Medical Center, Liebigstraße 10-14, 04103, Leipzig, Germany.,Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstraße 11, CH-8032, Zurich, Switzerland
| | - Cornelius Haffner
- Special Care- and Geriatric Dentistry, Städtisches Klinikum Harlaching München, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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Leick C, Larsen LB, Larrabee Sonderlund A, Svensson NH, Sondergaard J, Thilsing T. Non-participation in a targeted prevention program aimed at lifestyle-related diseases: a questionnaire-based assessment of patient-reported reasons. BMC Public Health 2022; 22:970. [PMID: 35562735 PMCID: PMC9107116 DOI: 10.1186/s12889-022-13382-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Having an unhealthy lifestyle is associated with a higher risk of developing lifestyle-related diseases. Current evidence suggests that interventions targeting health-risk behaviors can help people improve their lifestyles and prevent lifestyle-related diseases. However, preventive programs are often challenged by low participation rates. Reasons for non-participation include lack of time and/or interest, and/or no perceived need for lifestyle intervention. This study explores causes for non-participation in a sample of people who chose not to take up a targeted preventive program (TOF pilot2 study). Patient-reported reasons as well as sociodemographic characteristics and lifestyle factors are in focus. METHODS A total of 4633 patients from four Danish GP clinics received an invitation to take part in the TOF pilot2 study. Patients who chose not to participate in the TOF pilot2 study were asked to fill in a questionnaire concerning reasons for non-participation, lifestyle, BMI and self-rated health. Descriptive analyses were used to summarize the results. RESULTS A total of 2462 patients (53.1%) chose not to participate in the TOF pilot2 study. Among these, 84 (3.4%) answered the full questionnaire on reasons for not participating, lifestyle, BMI and self-rated health. The most common reasons for non-participation were lack of time, having an already healthy lifestyle, and feeling healthy. Based on their self-reported lifestyle 45 (53.6%) of the non-participants had one or more health-risk behaviors including smoking, unhealthy diet, BMI ≥ 35 and/or sedentary lifestyle and were therefore eligible to receive the targeted intervention at the GP or the MHC in the original TOF pilot2 study. CONCLUSION When planning future preventive programs it is important to know the main reasons for patients to not participate. This study provides rare insight into why people opt out of health interventions and advances the evidence base in this area. Our results may inform efforts to better involve these patients in preventive health programs. TRIAL REGISTRATION Trial registration number: NCT02797392 .
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Affiliation(s)
- Christian Leick
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Lars Bruun Larsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.,Steno Diabetes Center Sjælland, Holbæk, Denmark
| | - Anders Larrabee Sonderlund
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Nanna Herning Svensson
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Jens Sondergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Trine Thilsing
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
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