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Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial

Aim: A cluster randomized trial was conducted within 41 Japanese municipalities (21 intervention and 22 usual care) to examine whether the standardized health counseling for individuals at high cardiovascular risk screened at community sites accelerates clinic visits to strengthen the primary health...

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Autores principales: Iso, Hiroyasu, Noguchi, Midori, Yokoyama, Tetsuji, Yoshida, Toshiko, Saito, Isao, Shintani, Ayumi, Sairenchi, Toshimi, Nishizawa, Hitoshi, Imano, Hironori, Kitamura, Akihiko, Shimomura, Iichiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Japan Atherosclerosis Society 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10564631/
https://www.ncbi.nlm.nih.gov/pubmed/36878606
http://dx.doi.org/10.5551/jat.64100
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author Iso, Hiroyasu
Noguchi, Midori
Yokoyama, Tetsuji
Yoshida, Toshiko
Saito, Isao
Shintani, Ayumi
Sairenchi, Toshimi
Nishizawa, Hitoshi
Imano, Hironori
Kitamura, Akihiko
Shimomura, Iichiro
author_facet Iso, Hiroyasu
Noguchi, Midori
Yokoyama, Tetsuji
Yoshida, Toshiko
Saito, Isao
Shintani, Ayumi
Sairenchi, Toshimi
Nishizawa, Hitoshi
Imano, Hironori
Kitamura, Akihiko
Shimomura, Iichiro
author_sort Iso, Hiroyasu
collection PubMed
description Aim: A cluster randomized trial was conducted within 41 Japanese municipalities (21 intervention and 22 usual care) to examine whether the standardized health counseling for individuals at high cardiovascular risk screened at community sites accelerates clinic visits to strengthen the primary health care system. Methods: Among high-risk individuals aged 40–74 years screened by health checkups, 8,977 and 6,733 were allocated to the intervention and usual care groups, respectively, who were not under medical treatment but had high levels of blood pressure (systolic/diastolic ≥ 160/100 mmHg), hemoglobin A1c or glucose (≥ 7.0% or corresponding glucose levels), LDL-cholesterol (≥ 180 mg/dL for men), and/or proteinuria of ≥ 2+. The intervention was performed from May 2014 to March 2016 under a standardized health counseling program based on the health belief model primarily by public health nurses. The usual care group was provided with local counseling protocols. Results: The cumulative proportions of clinic visits for 12 months after health checkups were 58.1% (95% confidence interval, 57.0%, 59.3%) versus 44.5% (43.2%, 45.8%), with the probability ratio of clinic visits between the groups being 1.46 (1.24, 1.72). The between-group differences between the baseline and 1-year surveys were −1.50 (−2.59, −0.41) mmHg for diastolic blood pressure in the hypertension category, −0.30% (−0.53%, −0.07%) for HbA1c in the diabetes category, −0.37 (−0.48, −0.27) mmol/L for LDL-cholesterol in the dyslipidemia category, and none for proteinuria. Conclusion: Standardized health counseling for high-risk individuals accelerated clinic visits, with larger reductions in blood pressure, HbA1c, and LDL-cholesterol levels. The nationwide use of counseling after health checkups for high-risk individuals could help in controlling risk factors and in preventing lifestyle-related diseases.
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spelling pubmed-105646312023-10-12 Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial Iso, Hiroyasu Noguchi, Midori Yokoyama, Tetsuji Yoshida, Toshiko Saito, Isao Shintani, Ayumi Sairenchi, Toshimi Nishizawa, Hitoshi Imano, Hironori Kitamura, Akihiko Shimomura, Iichiro J Atheroscler Thromb Original Article Aim: A cluster randomized trial was conducted within 41 Japanese municipalities (21 intervention and 22 usual care) to examine whether the standardized health counseling for individuals at high cardiovascular risk screened at community sites accelerates clinic visits to strengthen the primary health care system. Methods: Among high-risk individuals aged 40–74 years screened by health checkups, 8,977 and 6,733 were allocated to the intervention and usual care groups, respectively, who were not under medical treatment but had high levels of blood pressure (systolic/diastolic ≥ 160/100 mmHg), hemoglobin A1c or glucose (≥ 7.0% or corresponding glucose levels), LDL-cholesterol (≥ 180 mg/dL for men), and/or proteinuria of ≥ 2+. The intervention was performed from May 2014 to March 2016 under a standardized health counseling program based on the health belief model primarily by public health nurses. The usual care group was provided with local counseling protocols. Results: The cumulative proportions of clinic visits for 12 months after health checkups were 58.1% (95% confidence interval, 57.0%, 59.3%) versus 44.5% (43.2%, 45.8%), with the probability ratio of clinic visits between the groups being 1.46 (1.24, 1.72). The between-group differences between the baseline and 1-year surveys were −1.50 (−2.59, −0.41) mmHg for diastolic blood pressure in the hypertension category, −0.30% (−0.53%, −0.07%) for HbA1c in the diabetes category, −0.37 (−0.48, −0.27) mmol/L for LDL-cholesterol in the dyslipidemia category, and none for proteinuria. Conclusion: Standardized health counseling for high-risk individuals accelerated clinic visits, with larger reductions in blood pressure, HbA1c, and LDL-cholesterol levels. The nationwide use of counseling after health checkups for high-risk individuals could help in controlling risk factors and in preventing lifestyle-related diseases. Japan Atherosclerosis Society 2023-10-01 2023-03-05 /pmc/articles/PMC10564631/ /pubmed/36878606 http://dx.doi.org/10.5551/jat.64100 Text en 2023 Japan Atherosclerosis Society https://creativecommons.org/licenses/by-nc-sa/4.0/This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/)
spellingShingle Original Article
Iso, Hiroyasu
Noguchi, Midori
Yokoyama, Tetsuji
Yoshida, Toshiko
Saito, Isao
Shintani, Ayumi
Sairenchi, Toshimi
Nishizawa, Hitoshi
Imano, Hironori
Kitamura, Akihiko
Shimomura, Iichiro
Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial
title Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial
title_full Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial
title_fullStr Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial
title_full_unstemmed Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial
title_short Effect of a Community-Based Program to Accelerate Referral to Physicians for Individuals at High-Risk of Lifestyle-Related Diseases: A Cluster Randomized Trial
title_sort effect of a community-based program to accelerate referral to physicians for individuals at high-risk of lifestyle-related diseases: a cluster randomized trial
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10564631/
https://www.ncbi.nlm.nih.gov/pubmed/36878606
http://dx.doi.org/10.5551/jat.64100
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