Effectiveness of the Population-based 'check Your Health Preventive Programme' Conducted in a Primary Care Setting: a Pragmatic Randomised Controlled Trial

Overview

Journal J Epidemiol Community Health

Specialty Health Services

Date 2021 Jun 19

PMID 34145078

Authors

Anne-Louise Bjerregaard

Else-Marie Dalsgaard

Niels-Henrik Bruun

Kasper Norman

Daniel R Witte

Henrik Stovring

Helle Terkildsen Maindal

Annelli Sandbaek

Affiliations

Soon will be listed here.

Abstract

Background: Health checks have been suggested as an early detection approach aiming at lowering the risk of chronic disease development. This study aimed to evaluate the effectiveness of a health check programme offered to the general population, aged 30-49 years.

Methods: The entire population aged 30-49 years (N=26 216) living in the municipality of Randers, Denmark, was invited to a health check during 5 years. A pragmatic household cluster-randomised controlled trial was conducted in 10 505 citizens. The intervention group (IG, N=5250) included citizens randomised to the second year and reinvited in the 5th year. The comparison group (CG, N=5255) included citizens randomised to the 5th year. Outcomes were modelled cardiovascular disease (CVD) risk; self-reported physical activity (PA) and objectively measured cardio respiratory fitness (CRF); self-rated health (short-form 12 (SF-12)), self-rated mental health (SF-12_Mental Component Score (MCS)) and, registry information on sick-leave and employment. Due to low participation, we compared groups matched on propensity scores for participation when reinvited.

Results: Participation in the first health check was 51% (N=2698) in the IG and 40% (N=2120) in the CG. In the IG 26% (N=1340) participated in both the first and second health checks. No intervention effects were found comparing IG and CG. Mean differences were (95% CI): modelled CVD risk: -0.052 (95% CI -0.107 to 0.003)%, PA: -0.156 (-0.331 to 0.019) days/week with 30 min moderate PA, CRF: 0.133 (-0.560 to 0.826) mL O/min/kg, SF-12: -0.003 (-0.032 to 0.026), SF-12_MCS: 0.355 (-0.423 to 1.132), sick leave periods ≥3 weeks: -0.004 (-0.025 to 0.017), employment: -0.004 (-0.032 to 0.024).

Conclusions: Preventive health checks offered to the general population, aged 30-49 years, had no effects on a wide range of indicators of chronic disease risk.

Trial Registration Number: NCT02028195.

References

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

Baumann S, Toft U, Aadahl M, Jorgensen T, Pisinger C . The long-term effect of screening and lifestyle counseling on changes in physical activity and diet: the Inter99 Study - a randomized controlled trial. Int J Behav Nutr Phys Act. 2015; 12:33. PMC: 4352560. DOI: 10.1186/s12966-015-0195-3. View

Summerton N . Delivery and impact of the NHS Health Check. Br J Gen Pract. 2018; 68(673):367. PMC: 6058627. DOI: 10.3399/bjgp18X698057. View

Si S, Moss J, Sullivan T, Newton S, Stocks N . Effectiveness of general practice-based health checks: a systematic review and meta-analysis. Br J Gen Pract. 2014; 64(618):e47-53. PMC: 3876170. DOI: 10.3399/bjgp14X676456. View

Conroy R, Pyorala K, Fitzgerald A, Sans S, Menotti A, De Backer G . Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24(11):987-1003. DOI: 10.1016/s0195-668x(03)00114-3. View

Sterne J, White I, Carlin J, Spratt M, Royston P, Kenward M . Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009; 338:b2393. PMC: 2714692. DOI: 10.1136/bmj.b2393. View

Baumann S, Toft U, Aadahl M, Jorgensen T, Pisinger C . The long-term effect of a population-based life-style intervention on smoking and alcohol consumption. The Inter99 Study--a randomized controlled trial. Addiction. 2015; 110(11):1853-60. DOI: 10.1111/add.13052. View

Krogsboll L, Jorgensen K, Larsen C, Gotzsche P . General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ. 2012; 345:e7191. PMC: 3502745. DOI: 10.1136/bmj.e7191. View

Blomstedt Y, Norberg M, Stenlund H, Nystrom L, Lonnberg G, Boman K . Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality: a cohort analysis based on 1 million person-years of follow-up in Västerbotten County, Sweden, during 1990-2006. BMJ Open. 2015; 5(12):e009651. PMC: 4691769. DOI: 10.1136/bmjopen-2015-009651. View

10.

Simmons R, Griffin S, Lauritzen T, Sandbaek A . Effect of screening for type 2 diabetes on risk of cardiovascular disease and mortality: a controlled trial among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009. Diabetologia. 2017; 60(11):2192-2199. PMC: 6108415. DOI: 10.1007/s00125-017-4299-y. View

11.

Artac M, Dalton A, Babu H, Bates S, Millett C, Majeed A . Primary care and population factors associated with NHS Health Check coverage: a national cross-sectional study. J Public Health (Oxf). 2013; 35(3):431-9. DOI: 10.1093/pubmed/fdt069. View

12.

Lauritzen T, Sig Ager Jensen M, Thomsen J, Christensen B, Engberg M . Health tests and health consultations reduced cardiovascular risk without psychological strain, increased healthcare utilization or increased costs. An overview of the results from a 5-year randomized trial in primary care. The Ebeltoft Health.... Scand J Public Health. 2008; 36(6):650-61. DOI: 10.1177/1403494807090165. View

13.

Austin P . Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2010; 10(2):150-61. PMC: 3120982. DOI: 10.1002/pst.433. View

14.

Stol D, Badenbroek I, Hollander M, Nielen M, Kraaijenhagen R, Schellevis F . Effectiveness of a stepwise cardiometabolic disease prevention program: Results of a randomized controlled trial in primary care. Prev Med. 2020; 132:105984. DOI: 10.1016/j.ypmed.2020.105984. View

15.

Jorgensen T, Jacobsen R, Toft U, Aadahl M, Glumer C, Pisinger C . Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ. 2014; 348:g3617. PMC: 4049194. DOI: 10.1136/bmj.g3617. View

16.

Lau C, Pisinger C, Husemoen L, Jacobsen R, Linneberg A, Jorgensen T . Effect of general health screening and lifestyle counselling on incidence of diabetes in general population: Inter99 randomised trial. Prev Med. 2016; 91:172-179. DOI: 10.1016/j.ypmed.2016.08.016. View

17.

Dryden R, Williams B, McCowan C, Themessl-Huber M . What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health. 2012; 12:723. PMC: 3491052. DOI: 10.1186/1471-2458-12-723. View

18.

Lund T, Labriola M, Christensen K, Bultmann U, Villadsen E . Physical work environment risk factors for long term sickness absence: prospective findings among a cohort of 5357 employees in Denmark. BMJ. 2006; 332(7539):449-52. PMC: 1382535. DOI: 10.1136/bmj.38731.622975.3A. View

19.

ASTRAND I . Aerobic work capacity in men and women with special reference to age. Acta Physiol Scand Suppl. 1960; 49(169):1-92. View

20.

Maindal H, Stovring H, Sandbaek A . Effectiveness of the population-based Check your health preventive programme conducted in primary care with 4 years follow-up [the CORE trial]: study protocol for a randomised controlled trial. Trials. 2014; 15:341. PMC: 4158060. DOI: 10.1186/1745-6215-15-341. View