1,721,167 research outputs found
An Individually Tailored Behaviour Change Programme for Cardiovascular Prevention: Effectiveness and Cost- Effectiveness
No full textCardiovascular disease (CVD) is the main cause of death and disability in
Europe and 10% of the total health care costs in the European Union is due
to CVD. This thesis provides original research on a cardiovascular prevention
programme focused on medical risk factors and risk behaviours such as an
unhealthy diet, low levels of physical activity, and smoking in a highly
educated sample. The behavioural interventions, namely a website and oneon-one coaching were part of an individually tailored behaviour change
programme. The effectiveness of this programme was evaluated compared
to a medical intervention only condition with total CVD risk assessment,
communication, and follow-up.
After 36 months improvements in most of the medical risk factors such as
blood pressure and cholesterol were found in both study conditions. The
effects of the programme on behaviour were evaluated at 6, 12, and 24
months and improvements in fat intake and physical activity were found in
both conditions.
The studies of this thesis corroborated the knowledge on intervention
exposure. The dose-response analyses showed that a higher intervention
dose led to better results in behaviour and determinants of behaviour. The
study on exposure to the website showed that the surfing depth was low in
general but an effect of use of tailored physical activity advice on physical
activity was found.
The participants of this study self-selected the intervention dose and delivery
modes of the intervention. For physical activity and dietary behaviours,
different delivery modes were effective. The Internet and e-mail were better
for physical activity while face-to-face contacts were better for dietary
behaviours.
Nevertheless, there were no significant differences between both study
conditions, suggesting that a medical screening with follow-up is sufficient to
change important CVD risk factors in the highly educated. The behaviour
change programme was effective in influencing key risk factors but screening
was as effective in this population. However, we should consider that partial
effects might be attributable to spontaneous changes of risk factors in the
community due to community interventions and health policy initiatives
(e.g., smoking, diet). Nevertheless, based on these results the organisation
of screening events with follow-up in the primary care setting is a good
action in CVD prevention in the highly educated
An Individually Tailored Behaviour Change Programme for Cardiovascular Prevention: Effectiveness and Cost- Effectiveness
No full textCardiovascular disease (CVD) is the main cause of death and disability in
Europe and 10% of the total health care costs in the European Union is due
to CVD. This thesis provides original research on a cardiovascular prevention
programme focused on medical risk factors and risk behaviours such as an
unhealthy diet, low levels of physical activity, and smoking in a highly
educated sample. The behavioural interventions, namely a website and oneon-one coaching were part of an individually tailored behaviour change
programme. The effectiveness of this programme was evaluated compared
to a medical intervention only condition with total CVD risk assessment,
communication, and follow-up.
After 36 months improvements in most of the medical risk factors such as
blood pressure and cholesterol were found in both study conditions. The
effects of the programme on behaviour were evaluated at 6, 12, and 24
months and improvements in fat intake and physical activity were found in
both conditions.
The studies of this thesis corroborated the knowledge on intervention
exposure. The dose-response analyses showed that a higher intervention
dose led to better results in behaviour and determinants of behaviour. The
study on exposure to the website showed that the surfing depth was low in
general but an effect of use of tailored physical activity advice on physical
activity was found.
The participants of this study self-selected the intervention dose and delivery
modes of the intervention. For physical activity and dietary behaviours,
different delivery modes were effective. The Internet and e-mail were better
for physical activity while face-to-face contacts were better for dietary
behaviours.
Nevertheless, there were no significant differences between both study
conditions, suggesting that a medical screening with follow-up is sufficient to
change important CVD risk factors in the highly educated. The behaviour
change programme was effective in influencing key risk factors but screening
was as effective in this population. However, we should consider that partial
effects might be attributable to spontaneous changes of risk factors in the
community due to community interventions and health policy initiatives
(e.g., smoking, diet). Nevertheless, based on these results the organisation
of screening events with follow-up in the primary care setting is a good
action in CVD prevention in the highly educated
The implementation of ICT in healthcare: an electronic cardiovascular risk calculator in general practice, a cost performance study
No full textIntroduction: Because health care (HC) budgets of European countries rise every year the discussion on how to finance HC in the new epidemiologic transition is eminent. The use of cheaper tools and techniques in prevention and HC seems advisable. In this study the case of cardiovascular diseases is the main focus. Cardiovascular diseases are the most important cause of morbidity and mortality. Guidelines to prevent these cardiovascular diseases are widely available. To implement these guidelines an electronic prevention programme (EPD) for general practitioners (GPs) is developed. This study calculated the implementation cost per working EPD (performance).
Methods: A prospective cost analysis and determination of the cost per performance with a one way sensitivity analysis were carried out. Logistic regression was performed to explore the predictive values of different variables with performance as a dependent variable.
Results: 185 GPs (response rate 23%) participated in the study. 99 are solo practitioners and 86 are working with at least one colleague (group practice). The total implementation cost of an EPD was €83.939. As the EPD was successfully installed by 102 GPs (=performance), the mean cost equals €823 per GP. Sensitivity analyses showed an improved cost per performance with decrease of the costs of group education and/or an increase in the performance. The most effective method for the implementation was the organisation of group education (OR=6; 95% CI 3.5-10) followed by working in a group practice (OR=3.6; CI 2.2-6).
Conclusion: Implementation of electronic programmes is expensive. Adequate funding has to be foreseen to implement quality improving ICT tools in general practice. Furthermore, results suggest that a significant number of GPs in the sample has problems with the installation and use of the tool in spite of all education and guidance
The implementation of ICT in healthcare: an electronic cardiovascular risk calculator in general practice, a cost performance study
No full textIntroduction: Because health care (HC) budgets of European countries rise every year the discussion on how to finance HC in the new epidemiologic transition is eminent. The use of cheaper tools and techniques in prevention and HC seems advisable. In this study the case of cardiovascular diseases is the main focus. Cardiovascular diseases are the most important cause of morbidity and mortality. Guidelines to prevent these cardiovascular diseases are widely available. To implement these guidelines an electronic prevention programme (EPD) for general practitioners (GPs) is developed. This study calculated the implementation cost per working EPD (performance).
Methods: A prospective cost analysis and determination of the cost per performance with a one way sensitivity analysis were carried out. Logistic regression was performed to explore the predictive values of different variables with performance as a dependent variable.
Results: 185 GPs (response rate 23%) participated in the study. 99 are solo practitioners and 86 are working with at least one colleague (group practice). The total implementation cost of an EPD was €83.939. As the EPD was successfully installed by 102 GPs (=performance), the mean cost equals €823 per GP. Sensitivity analyses showed an improved cost per performance with decrease of the costs of group education and/or an increase in the performance. The most effective method for the implementation was the organisation of group education (OR=6; 95% CI 3.5-10) followed by working in a group practice (OR=3.6; CI 2.2-6).
Conclusion: Implementation of electronic programmes is expensive. Adequate funding has to be foreseen to implement quality improving ICT tools in general practice. Furthermore, results suggest that a significant number of GPs in the sample has problems with the installation and use of the tool in spite of all education and guidance
The implementation of an electronic cardiovascular risk calculator in general practice: a cost performance study
No full textThe impact of hearth failure on health care costs in Belgium
No full textHeart failure (HF) is a serious public health problem all over the world. This chronic disease has a high prevalence, affects mainly the elderly and causes high mortality or severe disability with high economic costs. The aim of this study was to calculate the in-hospital costs due to HF in Belgium. Methods: Retrospective analysis of data from the national hospital registration system (MKG) for 2001. Cost calculations were performed using the data of the social insurance system (RIZIV). Results: In 2001, there were 19.398 admissions with HF as a primary diagnosis with a total in-hospital stay of 286.938 days, representing 12% of the total hospital days for cardiovascular diseases. The mean in-hospital stay for HF was 14.8 days. 51% of the patients were readmitted within the same year. The in-hospital mortality was 15.5%. The total in-hospital costs of HF as a primary diagnosis The impact of hearth failure on health care costs in Belgium. Conclusion: HF was responsible for a significant number of in-hospital days and in-hospital mortality. It has a significant impact on health care costs in Belgium
The implementation of an electronic cardiovascular risk calculator in general practice: a cost performance study
No full textCardiovascular is a major cause of mortality and morbidity and its prevalence is set to increase
No full textCardiovascular is a major cause of mortality and morbidity and its prevalence is set to increase. While the benefits of medical and lifestyle interventions is established, the effectiveness of interventions which seek to improve the way preventive care is delivered in primary care is less so. The purpose was to study the effectiveness of 2 intervention programs in reducing cardiovascular risk factors within primary care.
Methods: A randomized controlled trial conducted in Belgium 2007-2010 with 295 participants allocated to a medical (=MP) and a medical + behavioral (=MBP) program. The MP consisted of medical assessments (screening and follow-up) by a general practitioner. The BP was a tailored behavior change program (web-based and individual coaching). The dose of the coaching was chosen by the participants. Primary outcome measures were total cholesterol, blood pressure, and body mass index (BMI). The secondary outcomes were smoking status, fitness-score, total cardiovascular risk and events.
Results: The median age was 40 years (IQR 32– 49), 75 participants were female, 6 had a personal cardiovascular event and 3 had diabetes. The median total cholesterol was 181,5 mg/dl (IQR 165 – 207), median systolic pressure 130 mmHg (IQR 120 – 140), median diastolic blood pressure 83 mmHg (IQR 75 - 90) and median BMI was 25 kg/ m² (IQR 22 - 27). Being a smoker was reported by 48 of the participants. There were no significant differences in baseline characteristics between MP and MBP. Our drop-out after three years of intervention was 13%. there was a significant decrease in total cholesterol (median difference: -4,5 mg/dl; p<0,001), systolic blood pressure (-1 mmHg; p=0,016), and diastolic blood pressure (-16,5 mmHg; p<0,001). There was a significant increase in BMI (+0,3 kg/m²; p<0,001). There were no significant differences found between MP and MBP in primary outcomes. At baseline, 48 participants were smoker compared to 29 at the study endpoint. Overall there was a significant decrease in fitness-score (median difference: -2; p=0,035). Calculation of the total cardiovascular risk for participants gave a median score of 0,35 (IQR 0,11 – 1,19) at baseline and 0,34 (IQR 0,091 – 1,11) at end-point (p<0,001). During the study period one participant in the MBP had a cardiovascular event.
Conclusion: Both intervention programs are effective in reducing cardiovascular risk factors. In our population the combined medical and behavioural program was not superior to the medical program
Cardiovascular is a major cause of mortality and morbidity and its prevalence is set to increase
No full textCardiovascular is a major cause of mortality and morbidity and its prevalence is set to increase. While the benefits of medical and lifestyle interventions is established, the effectiveness of interventions which seek to improve the way preventive care is delivered in primary care is less so. The purpose was to study the effectiveness of 2 intervention programs in reducing cardiovascular risk factors within primary care.
Methods: A randomized controlled trial conducted in Belgium 2007-2010 with 295 participants allocated to a medical (=MP) and a medical + behavioral (=MBP) program. The MP consisted of medical assessments (screening and follow-up) by a general practitioner. The BP was a tailored behavior change program (web-based and individual coaching). The dose of the coaching was chosen by the participants. Primary outcome measures were total cholesterol, blood pressure, and body mass index (BMI). The secondary outcomes were smoking status, fitness-score, total cardiovascular risk and events.
Results: The median age was 40 years (IQR 32– 49), 75 participants were female, 6 had a personal cardiovascular event and 3 had diabetes. The median total cholesterol was 181,5 mg/dl (IQR 165 – 207), median systolic pressure 130 mmHg (IQR 120 – 140), median diastolic blood pressure 83 mmHg (IQR 75 - 90) and median BMI was 25 kg/ m² (IQR 22 - 27). Being a smoker was reported by 48 of the participants. There were no significant differences in baseline characteristics between MP and MBP. Our drop-out after three years of intervention was 13%. there was a significant decrease in total cholesterol (median difference: -4,5 mg/dl; p<0,001), systolic blood pressure (-1 mmHg; p=0,016), and diastolic blood pressure (-16,5 mmHg; p<0,001). There was a significant increase in BMI (+0,3 kg/m²; p<0,001). There were no significant differences found between MP and MBP in primary outcomes. At baseline, 48 participants were smoker compared to 29 at the study endpoint. Overall there was a significant decrease in fitness-score (median difference: -2; p=0,035). Calculation of the total cardiovascular risk for participants gave a median score of 0,35 (IQR 0,11 – 1,19) at baseline and 0,34 (IQR 0,091 – 1,11) at end-point (p<0,001). During the study period one participant in the MBP had a cardiovascular event.
Conclusion: Both intervention programs are effective in reducing cardiovascular risk factors. In our population the combined medical and behavioural program was not superior to the medical program
Validation of a single‐stage fixed‐rate step test for the prediction of maximal oxygen uptake in healthy adults
No full textHealthcare professionals with limited access to ergospirometry remain in need of valid and simple submaximal exercise tests to predict maximal oxygen uptake (VO2max). Despite previous validation studies concerning fixed-rate step tests, accurate equations for the estimation of VO2max remain to be formulated from a large sample of healthy adults between age 18–75 years (n > 100). The aim of this study was to develop a valid equation to estimate VO2max from a fixed-rate step test in a larger sample of healthy adults. A maximal ergospirometry test, with assessment of cardiopulmonary parameters and VO2max, and a 5-min fixed-rate
single-stage step test were executed in 112 healthy adults (age 18–75 years). During the step test and subsequent recovery, heart rate was monitored continuously. By linear regression analysis, an equation to predict VO2max from the step test was formulated. This equation was assessed for level of agreement by displaying
Bland–Altman plots and calculation of intraclass correlations with measured VO2max. Validity further was assessed by employing a Jackknife procedure. The linear regression analysis generated the following equation to predict VO2max (l min 1) from the step test: 0054(BMI)+0612(gender)+3359(body height in m)+0019(fitness index) 0012(HRmax) 0011(age) 3475. This equation explained 78% of the variance in measured VO2max (F = 6615, P<0001). The level of agreement and intraclass correlation was high (ICC = 094, P<0001)
between measured and predicted VO2max. From this study, a valid fixed-rate single-stage step test equation has been developed to estimate VO2max in healthy adults. This tool could be employed by healthcare professionals with limited access to ergospirometry.This study was partially funded by the scientific chair ‘De Onderlinge Ziekenkas preventie’ and by a research grant from
Hartcentrum Hasselt, Belgium
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