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Samara Rosenfeld 


Personal digital health profiles show promise in a step-wise approach to chronic disease prevention, according to research published in the journal BMC Public Health.
 
Of the 22% of patients advised to get a health check at their general practitioner, almost all of them (19%) did. And of the nearly 25% of patients advised to schedule an appointment for behavior-change counseling at their municipal health center, 21% took the advice.
 
Participants who had fair or poor self-rated health, a body mass index above 30, low self-efficacy, were female, non-smokers or who led a sedentary lifestyle were more likely to attend targeted preventive programs.
 
A Danish research team implemented a step-wise approach in the Danish primary care sector for the systematic and targeted prevention of chronic disease.
 
The researchers designed an early detection and prevention intervention for Type 2 diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease (COPD). The intervention had two elements:

  1. General intervention. This involved the creation of a personal digital health profile for each individual in the study population.
  2. Targeted intervention. This intervention included a health check at the general practitioner or behavior-change counseling at a municipal health center. The targeted interventions were for patients who were deemed likely to benefit from such interventions due to their high overall risk of the chronic conditions or because they regularly engaged in health-risk behaviors.

More than 8,800 patients between the ages of 29 and 60 from 47 general practitioners participated in the study.
 
Participants received a digital invitation and consent form prior to the study.
 
The aims of the digital health profiles were centered on four key ideas:

  1.  To motivate and enable patients who otherwise would not have taken up a targeted intervention like the one offered.
  2. To motivate and enable patients with poor self-management skills to take up the targeted intervention.
  3. To guide patients with good self-management skills to change their own behavior.
  4. To keep the healthy and low-risk population from demanding unnecessary health checks from their general practitioner. 

Digital health profiles contained clear and concise personalized health information and recommendations for further action. Recommendations included advice to take up a targeted preventive program, facts about health-risk behavior, information about the positive impact of behavior-change and a personalized list of available and relevant behavior-change interventions.
 
Researchers created the digital health profiles based on the patients’ electronic health records and questionnaire information, which included health-risk behaviors, family history of disease, early symptoms of COPD and osteoarthritis.
 
Participants were then stratified into one of four groups.

The first group consisted of patients who had treatment for hypertension, hyperlipidemia, Type 2 diabetes mellitus, cardiovascular disease and/or COPD at their general practitioner. The patients in this group did not have any additional intervention beyond usual care.

 Patients in the second group were those would likely benefit from a health check at their general practitioner determined by three risk algorithms for the chronic conditions. These patients were advised to schedule a check with their practitioner, which included a medical examination and subsequent health counseling session.

In the third group were patients who were not flagged by the risk algorithms but had a body mass index above 35 and/or reported they regularly engaged in health-risk behavior. Risky behaviors included daily smoking, high-risk alcohol consumption, unhealthy dietary habits and sedentary leisure time activities. Patients in this group were advised to schedule a 15-minute telephone-based counseling session. These could be requested online through the digital health profile.

 Patients with a healthy lifestyle and no need for further intervention made up the fourth group.
 

Deciphering the Findings

Women and participants with sedentary leisure behavior were more likely to attend a health check at their general practitioner. General practitioner attendance rates revealed that physical activity was the strongest predictor of attendance. The attendance for those with sedentary behavior was 28%, while those who exercised during down time was 17%.
 
Of those who had fair or poor self-related health, 20% of smokers attended the telephone-based counseling session and 42% of the non-smokers attended.
 
Overall, the attendance rate for patients who were advised to schedule a health check and for those who were advised to schedule a counseling session was near 20%.
 
“This study suggests that a personal digital health profile may help foster a more equitable uptake of preventive programs in the primary care sector — especially among patients with lower self-efficacy and fair to poor self-related health,” the authors wrote.
 
The researchers suggest that further research is needed on personal digital health profiles.