Evaluation of intervention programmes for hypercholesterolaemia, excessive drinking and physicians' prescribing in primary care
Author: Tomson, Ylva
Date: 1997-12-12
Location: Föreläsningssalen M63, Huddinge sjukhus
Time: 9.00
Abstract
Interventions against riskful lifestyles and information to promote
rational use of drugs are important in health care. The aim of this
thesis is to assess the effectiveness of such interventions, looking at
both costs and effects.
In the catchment area of Vårby Health Centre, all subjects, aged 25-54
years, were offered a health check and 2 338 subjects participated. In
this population, 40% were immigrants, mainly from Finland and the
Mediterranean area. Smoking habits, length, weight, blood pressure, blood
glucose, serum-cholesterol (S-Chol) and serum gamma-glutamyl transferase
(GGT) were checked. Those with S-Chol in the range 6.5-7.0 mMol/l were
randomised into a medium-intensity and a low intensity
non-pharmacological treatment, comparing the values, costs and effects of
the intervention. 222 individuals had GGT above 0.89 ukat/l, 100 were
randomised to a nurse-conducted intervention group and 122 to a control
group. The brief intervention aimed at reducing alcohol consumption in
excessive drinkers. The investigation of the population of Vårby showed
important ethnic differences in risk factor patterns. The Finns had the
highest mean S-Chol levels and blood pressures. The Mediterranean group,
in spite of a significantly higher body mass index, had blood pressures
that were significantly lower compared with the Swedes and the Finns.
Smoking rates among the Mediterranean men were high (58%) compared with
the national smoking rate (27%). The non pharmacological intervention
against hypercholesterolaemia resulted in a decrease in total S-Chol of
3.5% in both groups. The intervention cost per subject in the
low-intensity group was SEK 753 and in the medium-intensity group SEK 3
614. Therefore the brief intervention in the low-intensity group is to be
preferred from the cost-effectiveness point of view. The brief
intervention among the excessive drinkers resulted in significant
reductions of both GGT and mean weekly alcohol consumption.
General practitioners (GPs) at all the 27 health centres in an area of
Stockholm County were given feed-back on their own prescriptions. From
prescription data collected at the local pharmacies, the number of drugs
used, defined daily doses per drug group, and drug costs were measured. A
second controlled study focused on the pharmacological treatment of
asthma bronchiale, assessing the GPs' knowledge of the diagnosis, and
treatment, their prescribing and the asthmatic patients' knowledge of
their disease before and after intervention.
The base-line prescription survey revealed major differences between
health centres. This incited the GPs to arrange workshops on drug use in
primary care. The GPs developed a drug list of 167 recommended drugs. At
the follow-up, there was a clear trend towards smaller volumes and cost
per prescription item for the health centres in the study area. Compared
with the national prescribing pattern, prescribing in the study area
represented a 20% lower drug cost .
The asthma-treatment intervention showed significant differences between
the intervention and the control area as regarding the knowledge of the
GPs after the intervention. There was a significant change in prescribing
in the intervention area; the change was in line with the intervention
message. It is concluded that interventions aiming to affect lifestyle
have to involve the recipient actively in order to obtain a change.
Because health-care resources are scarce, there is a need to compare
different strategies for treatment, looking at both the medical and the
financial consequences.
Issue date: 1997-11-21
Publication year: 1997
ISBN: 91-628-2770-7
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