The association between GP organizational factors and the effectiveness of a prevention program for cardiometabolic diseases: a prospective intervention study

Abstract

Background: Due to the rising disease burden of cardiometabolic diseases (CMD), prevention programs for CMD are increasingly implemented in primary care. Organizational practice characteristics and availability of preventive services may be associated with a more effective program. Aim: To identify possible organizational success factors from general practices related to an effective primary prevention program for CMD. Design & setting: A prospective intervention study involving 37 Dutch general practices. Method: Patients aged 45-70 years without known CMD, hypertension or hypercholesterolemia were invited for the prevention program. The outcome measures were an improvement (yes/no) in four different CMD risk factors between baseline and one year follow-up on individual level (BMI, smoking, systolic blood pressure and cholesterol ratio). Multivariate logistic regression analysis was used for assessing associations between practice organizational characteristics and outcomes. Results: Just over half of the participants showed an improvement on one or more risk factors. Marginal differences were found in the four different outcomes between the practices with different organizational characteristics. None of the practice characteristics we tested showed a significant association with an improvement in one of the outcome measures. Conclusion: In this study general practice organizational and preventive services characteristics showed no impact on the effectiveness of a CMD prevention program. Possible explanations could be the effectiveness of protocolized pharmaceutical treatment and only limited contribution of lifestyle programs on the improvement of CMD risk factors. Key words: general practice; primary health care; primary prevention; cardiovascular diseases; risk assessment; organization and administration.