The PreventieConsult and hard-to-reach patients; [Het PreventieConsult en ‘moeilijk bereikbare’ patiënten]

Abstract: Groenenberg I, Crone MR, Van Dijk S, Ben Meftah J, Hettinga DM, Middelkoop BJC, Stiggelbout AM, Assendelft WJJ. The PreventieConsult and hard-to-reach patients. Huisarts Wet 2015;59(8):338-42. Background: Cardiometabolic screening programmes fail if they do not succeed in reaching vulnerable groups. We investigated to what extent general practice patients with a low socioeconomic status (SES) or immigrant background participated in a prevention consultation, the ‘PreventieConsult’ – what proportion of patients assessed as having an increased risk actually came to the consultation, which risk factors the general practitioner recorded, and follow-up outcomes. Method: Cross-sectional study of the patient records of six general practices in deprived areas of The Hague and surroundings. This study was part of CHECK’D, a study regarding a adapted invitation strategy for the PreventieConsult involving 1645 patients aged 45-70 years with a low SES or a Turkish, Moroccan, or Surinamese background (the age range for the Hindostani-Surinamese participants was 35-70 years). Participants with a high risk score (above the cut-off value) were included in this sub-study (n = 208). The data were derived from the cardiovascular risk management protocol, laboratory data, and the GP log. Results: Of the theoretical 208 consultations for the high-risk patients, 148 (71[%]) were actually carried out; native Dutch patients were least likely to attend. The patient records for these consultations were incomplete, so that the risk assessment score could be established for only 4 participants (3[%]) – the score was indeed higher than the cut-off in all cases. The cardiovascular risk score could be calculated for 66 (44[%]) participants and was raised (in the yellow or red area in the risk table) in 26 (39[%]) participants. Medication was prescribed for 29 (20[%]) participants: 7 (5[%]) an oral antidiabetic agent, 12 (8[%]) an antihypertensive, and 17 (11[%]) a statin. In total, 53 participants (36[%]) were given lifestyle advice (nutrition, physical activity), and 44 of the 64 smokers (69[%]) were advised to stop smoking. Conclusion: With an adapted invitation strategy, it is possible to achieve a participation rate among hard-to-reach groups comparable to or even higher than that among the general population. It is important that GPs should not only record classic risk factors for cardiovascular disease and diabetes, but also other risk factors associated with cardiometabolic disorders, such as family history, and the lifestyle advice given. The GP has an important role in the management of these risk factors, especially in hard-to-reach patient groups. This role has become even more important now that the PreventieConsult has been incorporated into a personal health check, which is being implemented in primary care and elsewhere. © 2016, Bohn Stafleu van Loghum.