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Primary Care as an Arena For Primary, Secondary, and Tertiary Vardiovascular Disease Prevention

Ovhed, Ingvar LU (1998)
Abstract (Swedish)
Popular Abstract in Swedish

Förebyggande av hjärtkärlsjukdom har varit en utmaning för medicinsk forskning under flera decennier. Viktiga frågeställningar om såväl screeningmetodik som risk-faktor intervention söker fortfarande sitt svar och har i sig betydelse för både samhällsmedicin och klinisk verksamhet. Målsättningen för denna studie var att undersöka möjligheten för läkare och sjuksköterskor, att utgående från ett medvetet vidgat konsultationsbegrepp, aktivt arbeta preventivt. Den etablerade blodtryckskontrollen var utgångspunkt för inklusion i en opportunistisk screening för förhöjda kolesterolvärden. Läkaren gav råd om rökstopp och var den som initierade och därför också kontrollerade inklusionen.... (More)
Popular Abstract in Swedish

Förebyggande av hjärtkärlsjukdom har varit en utmaning för medicinsk forskning under flera decennier. Viktiga frågeställningar om såväl screeningmetodik som risk-faktor intervention söker fortfarande sitt svar och har i sig betydelse för både samhällsmedicin och klinisk verksamhet. Målsättningen för denna studie var att undersöka möjligheten för läkare och sjuksköterskor, att utgående från ett medvetet vidgat konsultationsbegrepp, aktivt arbeta preventivt. Den etablerade blodtryckskontrollen var utgångspunkt för inklusion i en opportunistisk screening för förhöjda kolesterolvärden. Läkaren gav råd om rökstopp och var den som initierade och därför också kontrollerade inklusionen. Mottagningsköterskan administrerade och genomförde det individuella upp-följningsprogrammet. Programmets genomförbarhet undersöktes genom bestämning av antalet inkluderade i förhållande till totalpopulation resp. till den andel av befolkningen som besökt vårdcentralen. Bortfallet studerades vad gällde ålders- och riskfaktorfördelning och en telefonintervjustudie genomfördes för att mäta medvetenhet och behandling av riskfaktorer för hjärtkärlsjukdom i befolkningen. Sjuksköterskans roll och värdet av lokala vårdprogram studerades i två diabetespopulationer som listats vid sina vårdcentraler. Slutligen jämfördes i en randomiserad studie kvaliteten av vården efter hjärtinfarkt i primärvård och vid invärtesmedicinsk klinik. I en integrerad opportunistisk screening inkluderades under tre år en tredjedel av befolkningen mellan 40 och 59 år. Bortfall från uppföljningen var beroende av ålder och riskfaktormönster. Det fanns en ökad medvetenhet hos den del av befolkningen som kände till projektet jämfört med de som inte gjorde detta, vilket bedömdes tyda på en befolkningseffekt från den genomförda screeninginsatsen. Summaresultatet av rökavvänjningsinsatserna var negativt och det framkom att rökare genomför återkommande långvariga rökstopp. Vid en vårdcentral med en tydligt strukturerad verksamhet, där sjuksköterskorna använde lokala vårdprogram och checklistor, konstaterades en högre kvalitet inom diabetesvården. En randomiserad ettårsuppföljning efter hjärtinfarkt visade inte några statistiskt signifikanta skillnader vad gällde andelen reinfarkter, återinläggningar, kranskärlsoperationer eller sekundärpreventiv medicinering. Sammanfattande slutsatser blir att en opportunistisk screening är lättast genomförbar i medelåldern mellan 40 och 59 år, och att särskilda resurser knappast krävs om verksamheten integreras med etablerad blodtryckskontroll. Rökav-vänjningshjälp måste ske utgående från kunskapen om, att för de flesta som slutar röka är det en lång process med många återfall. I befolkningen är det idag skillnad mellan kontroll av blodtrycks- och koles-terolvärde. Screeningaktiviteter tycks öka medvetenheten om riskfaktorer för hjärt- kärlsjukdom och även kunna ge spridningseffekter i en population. Den diabetesutbildade sjuksköterskan är en värdefull medlem av primärvårdsorganisa-tionen, men lokala checklistor och vårdprogram bör användas. Av de patienter som haft en akut hjärtinfarkt och är yngre än 75 år kräver drygt 40 procent specialist-resurser, medan huvuddelen av de övriga kan följas upp inom primärvården. Samarbetet mellan cardiologi och primärvård är i detta sammanhang troligen av särskild betydelse. (Less)
Abstract
Cardiovascular disease prevention has been a challenge for research for decades. The studies of this thesis were designed to investigate the role of health professionals in everyday clinical work based upon the concept of comprehensive primary care consultation. Routine check-up of blood pressure was the basis for the inclusion in an opportunistic screening for hyperchol-esterolaemia. Additionally, advice on smoking cessation was given. The doctor was the initiator, and could control the rate of inclusion. The nurses administered and performed the individual follow-ups. A telephone survey was used to investigate awareness and treatment of cardiovascular risk in the population. The value of local guidelines and responsi-bilities of the... (More)
Cardiovascular disease prevention has been a challenge for research for decades. The studies of this thesis were designed to investigate the role of health professionals in everyday clinical work based upon the concept of comprehensive primary care consultation. Routine check-up of blood pressure was the basis for the inclusion in an opportunistic screening for hyperchol-esterolaemia. Additionally, advice on smoking cessation was given. The doctor was the initiator, and could control the rate of inclusion. The nurses administered and performed the individual follow-ups. A telephone survey was used to investigate awareness and treatment of cardiovascular risk in the population. The value of local guidelines and responsi-bilities of the nurse on quality of care was studied in two populations of diabetics defined by their primary health care center (PHCC) listing. Finally, a randomized study of follow-up 15 months of post acute myocardial infarction (AMI) was used to compare quality of care in primary and in hospital clinic care. Opportunistic screening integrated in day-to-day patient care during three years with inclusion controlled by the physi-cian included one third of the population aged 40 - 59 years. There was increased awareness of individual risks factors among those aware of but not included in the project, indicating a population impact of the opportunistic screening. The net result of smoking cessation at the two year follow-up was negative. Smokers frequently make long-lasting quitting attempts. There was a higher quality of care of non-insulin-dependent diabetes mellitus (NIDDM) in a PHCC having a structured management with nurses using local guidelines and check-lists. A randomised one-year follow-up in primary care and at the department of internal medicine post AMI did not show any statistically significant differences in the proportion of readmitted patients, coronary by pass surgery, or secondary preventive medication. Opportunistic screening is most feasible in ages 40-59 years. If integrated with regular case-finding and treatment for hypertension, few extra resources are needed for implementation. Smoking cessation must be recognized as a long-lasting process with patients leaving and entering the ?risk-zone?. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities. Screening activities may rise the awareness of cardiovascular risk factors in the population. The diabetes educated practice nurse is a valuable contribution to the PHC organization, provided that guide-lines are implemented to guide day-to-day work with these patients. About 40 per cent of patients younger than 75 years discharged after an AMI should require the specialized resources of hospital. Most re-maining patients can use a low resource follow-up in general practice as safely as at the specialized out-patient clinic. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Docent Björkelund, Cecilia, Göteborg
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Cardiovascular system, samhällsmedicin, Socialmedicin, Social medicine, primary health care, Opportunistic screening, consultation, primary prevention, secondary prevention, tertiary prevention, hypercholesterolaemia, hypertension, smoking, coronary disease, NIDDM, smoking cessation, awareness, general pract, self-monitoring, Kardiovaskulära systemet
pages
108 pages
publisher
Ingvar Ovhed, Grytstigen 1, SE-37160 Lyckeby,
defense location
Stora aulan MFC, Univ.sjukh. Malmö
defense date
1998-10-29 09:15
external identifiers
  • Other:ISRN: LUMEDW/MESO--1018--SE
ISBN
91-628-3181-X
language
English
LU publication?
yes
id
316cab1a-04e2-4c9b-9edc-84e40c8ebb67 (old id 38981)
date added to LUP
2007-08-01 15:42:49
date last changed
2016-09-19 08:45:06
@misc{316cab1a-04e2-4c9b-9edc-84e40c8ebb67,
  abstract     = {Cardiovascular disease prevention has been a challenge for research for decades. The studies of this thesis were designed to investigate the role of health professionals in everyday clinical work based upon the concept of comprehensive primary care consultation. Routine check-up of blood pressure was the basis for the inclusion in an opportunistic screening for hyperchol-esterolaemia. Additionally, advice on smoking cessation was given. The doctor was the initiator, and could control the rate of inclusion. The nurses administered and performed the individual follow-ups. A telephone survey was used to investigate awareness and treatment of cardiovascular risk in the population. The value of local guidelines and responsi-bilities of the nurse on quality of care was studied in two populations of diabetics defined by their primary health care center (PHCC) listing. Finally, a randomized study of follow-up 15 months of post acute myocardial infarction (AMI) was used to compare quality of care in primary and in hospital clinic care. Opportunistic screening integrated in day-to-day patient care during three years with inclusion controlled by the physi-cian included one third of the population aged 40 - 59 years. There was increased awareness of individual risks factors among those aware of but not included in the project, indicating a population impact of the opportunistic screening. The net result of smoking cessation at the two year follow-up was negative. Smokers frequently make long-lasting quitting attempts. There was a higher quality of care of non-insulin-dependent diabetes mellitus (NIDDM) in a PHCC having a structured management with nurses using local guidelines and check-lists. A randomised one-year follow-up in primary care and at the department of internal medicine post AMI did not show any statistically significant differences in the proportion of readmitted patients, coronary by pass surgery, or secondary preventive medication. Opportunistic screening is most feasible in ages 40-59 years. If integrated with regular case-finding and treatment for hypertension, few extra resources are needed for implementation. Smoking cessation must be recognized as a long-lasting process with patients leaving and entering the ?risk-zone?. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities. Screening activities may rise the awareness of cardiovascular risk factors in the population. The diabetes educated practice nurse is a valuable contribution to the PHC organization, provided that guide-lines are implemented to guide day-to-day work with these patients. About 40 per cent of patients younger than 75 years discharged after an AMI should require the specialized resources of hospital. Most re-maining patients can use a low resource follow-up in general practice as safely as at the specialized out-patient clinic.},
  author       = {Ovhed, Ingvar},
  isbn         = {91-628-3181-X},
  keyword      = {Cardiovascular system,samhällsmedicin,Socialmedicin,Social medicine,primary health care,Opportunistic screening,consultation,primary prevention,secondary prevention,tertiary prevention,hypercholesterolaemia,hypertension,smoking,coronary disease,NIDDM,smoking cessation,awareness,general pract,self-monitoring,Kardiovaskulära systemet},
  language     = {eng},
  pages        = {108},
  publisher    = {ARRAY(0x9758910)},
  title        = {Primary Care as an Arena For Primary, Secondary, and Tertiary Vardiovascular Disease Prevention},
  year         = {1998},
}