General Practice

Lifestyle-related diseases such as diabetes, cardiovascular disorders, and certain types of cancer have increased the disease burden on individuals and on societies. Scientific findings indicate that healthy food, regular exercise, and tobacco cessation can reduce the prevalence of coronary heart diseases, stroke and diabetes by 80 percent, and the prevalence of certain cancers by 40 per cent. Thus, the potential for improving public health is huge.

 

Prevention efforts can target structural changes in society, life-style changes for the individual, or both. In the course of a year, general practitioners (GPs) in Denmark come into contact with about 90 percent of people registered with their practice. GPs are therefore in an excellent position to help individuals improve their health through life-style changes, in order to prevent diseases and premature death.

The Section for General Practice conducts work to solve question such as these:

  • Can GPs help the individual to attain a better quality of life, reduce the risk of lifestyle-related diseases, and improve survival by giving people the opportunity to attend a medical health check followed by a health conversation?
  • How can GPs motivate the individual to make healthier lifestyle choices?
  • How can GPs best help individuals to make healthier choices and, when relevant, improve compliance with prescribed preventive medication?
  • Which factors predict an unhealthy lifestyle, lifestyle diseases, and premature death?

Over the past 10 years we have conducted the ADDITION study, which evaluates the benefits and disadvantages of a high-risk screening program for diabetes in general practice. Some of our findings are now being incorporated into the clinical guidelines issued to Danish GPs.

In relation to health promotion, prevention, treatment, and rehabilitation we work with patient education, giving autonomy support and encouraging self-care and self-management. This education seeks to motivate and stimulate individuals to live with their disease, or to cope with the risk of becoming ill. Other research areas include childhood obesity, and living with several chronic conditions (multimorbidity).

We cooperate with national and international scientists from universities in Cambridge, Leicester, Utrecht, and elsewhere. In Denmark we also collaborate with the Danish Institute for Health Services Research, municipal authorities, and GPs across the country.

 

Projects

  • The Ebeltoft Health Promotion Project began in the early 1990s. It offered 2,000 citizens living in the municipality of Ebeltoft, and aged 30 to 50, medical checkups and consultations with their own GP. The study, lasting 5 years, demonstrated that such an initiative could reduce the number of people at risk of cardiovascular diseases from 18% to 10%.
  • The ADDITION study, initiated in Denmark, is an international study on the screening and treatment of people with asymptomatic diabetes. In Denmark, approximately 160,000 people ranging from 40 to 69 years of age were invited to sign up for screening. About 1,600 were identified with screen-detected diabetes; 2,300 had pre-diabetes; and 7,300 had a high risk of coronary heart diseases. The findings suggest that screening for diabetes is beneficial, and that screening for diabetes and screening for cardiovascular risk should be seen as integrated issues.
  • The Randers Health Promotion Project: “Check Your Health” is an extension of the project in Ebeltoft and the ADDITION study (both describe above), and it involves 36,000 citizens in the Municipality of Randers. “Check Your Health” seeks to further develop the concept of medical health checks in general practice.

 

Milestones

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 (Lauritzen T et al . The Ebeltoft Health Promotion Project (EHPP). Scand J Public Health 2008; 36(6):650-661).

Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial (Griffin SJ et al. . Lancet. 2011 Jul 9;378(9786):156-67).

Effect on motivation, perceived competence, and activation after participation in the ''Ready to Act'' programme for people with screen-detected dysglycaemia: a 1-year randomised controlled trial, Addition-DK (Maindal HT et al. . Scand J Public Health. 2011 May;39(3):262-71. Epub 2011 Mar 22).

Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study (Sandbaek A et al.. Diabetologia. 2008 Jul;51(7):1127-34. Epub 2008 Apr 29).

MMR vaccination and febrile seizures –  evaluation of susceptible subgroups and Long-term prognosis (Vestergaard M et al.  JAMA. 2004. 292: 351-357).

 

Metoder

  • Methods
  • Clinical studies, randomized controlled trials (RCT s), and cohort follow-up studies
  • Qualitative studies
  • Register-based studies
  • Health-service research