Participation rate in a stepwise cardiometabolic prevention program in primary care: the integrate study.

Background: The increasing burden of cardiometabolic disease (CMD) worldwide calls for an effective structural prevention program, embedded in primary care. The INTEGRATE study evaluates a cardiometabolic prevention program in primary care, in which individuals with an increased risk are identified and provided with tailored lifestyle advice and treatment. Objective: As successful implementation of CMD prevention programs strongly depends on participation, we aim to determine the participation rate in different steps of the program. Methods: “Personalized Prevention Approach for Cardio-Metabolic Risk” (PPA CMR) is a stepwise cardiometabolic prevention program, developed for individuals between 45 and 70 years of age without known CMD. The INTEGRATE study will implement this program in 40 general practices (n=30.000 eligible patients), starting March 2014. The first step of PPA CMR is an online risk estimation. We will send a paper version on request and ad a short translated explanation in different languages. In the second step, patients who found an increased risk for CMD during the risk estimation are invited to their GP for additional measurements and detailed profiling. The last step is treatment by lifestyle advice and/or medication when indicated. The study ends after one year of treatment. To obtain determinants for non-participation we will send questionnaires to non-responders in different stages of the study. In addition, we will assess practice characteristics such as indicators of practice management and the way lifestyle treatment is organized. The primary outcome is the participation rate (%) of all eligible participants at different stages of the study. Expected results: We expect one of the determining factors for the first step (risk estimation) to be: offering a paper or translated version of the questionnaire next to the online option. For the second step (assessment by GP) our idea is that active stimulation by practice nurses will increase compliance. For the last step (treatment) we expect to identify practice factors that predict successful participation in the program, such as tailored lifestyle treatment by offering lifestyle coaching and al local programmatic interventions. Conclusion: Willingness to participate is crucial for an effective prevention program. INTEGRATE will provide knowledge on key factors for successful participation in different stages of cardiometabolic prevention programs