“Today there is an important experience of healthy conversations”

Medicine said today In a news article on Dagensmedicin.se On October 14, 2021, Stockholm County is now proposing to conduct a pilot study with targeted health interviews and at the same time report critical comments from some general practitioners, who generally question the value of the method and claim that it has benefited and that patients really are being fired. After many years of preventive work in primary care, both in meetings with patients and as staff on teams tasked with developing outreach activities, we would like to give readers a different picture.

There is a very wide Swedish experience in the business model of targeted health interviews (=targeting chronic diseases, such as cardiovascular disease and diabetes) with which the majority of regions of the country work today. It was developed during the latter part of the 1980s in Västerbotten and Jönköping.

Read more: General practitioners are reluctant to invest in healthy conversations

In Västerbotten alone, more than 120,000 county residents aged 40, 50 and 60 have participated so far, and since most of them have returned after 10 and 20 years for a renewed meeting, more than 200,000 health interviews have been conducted. Since 2012, when health interviews became part of the primary care mission of outreach activities in the district of Jonkoping County, more than 60,000 targeted health interviews have been conducted among parents for the first time in the county and county 40, 50, 60 and 40 years. 70 years old.

In short, it works so that every ten years Primary Care invites every middle-aged person to a health screening, focusing on lifestyle and risk factors for chronic disease, primarily cardiovascular disease, along with individual health talk about outcomes and related health respect .

As early as the 1930s, models for children’s health centers began to be developed in Sweden to provide young children and parents with support with health issues. Targeted conversations are based on the same population-oriented idea: the intent is that primary care as a complement to its clinical activities advances outreach efforts to provide early support primarily for changes in unhealthy lifestyles that, if unchanged, can turn into serious illness.

Today, there is a lot of experience in the method of work. It works, and it reaches different educational groups almost equally, and lifestyles and disease states, such as diabetes, are caught early, which reduces complications and significantly reduces mortality, compared to patients diagnosed through routine primary care. Health economic analyzes show that the method of operation is very cost-effective, both for health care and for the national economy, and for health care it is cost-effective, which means that more money is diverted to other important areas.

The role of physicians in the business model is limited, but as a role model and team leader, the physician has an important role. The work is mainly performed by district nurses. Studies show that about 20 percent of participants have some skewed results that lead to continued efforts from various care professions. The methods applied by district nurses are evidence-based and based on the National Board of Health and Care’s National Guidelines for Unhealthy Lifestyles, which are also the same methods that guide clinicians in patient work.

So far, the method of work has been applied mainly in smaller regions of the country. Now that since 2020 Skåne has been inviting residents to targeted health talks, the opportunity is being given to develop the model in a broader context. As in the current Stockholm proposal, the Skåne district has also begun an experimental attempt to find its way of working. A pilot study in Stockholm, focusing in particular on regions with large numbers of ill health and financial vulnerability, could provide a good basis for the future. But it can also give everyone across the country valuable experience and inspiration for advancing outreach efforts for the very groups where the need for lifestyle changes is greatest.

Lars Weinhall, General Practitioner in Västerbotten, Professor of General Medicine and Epidemiology, Umeå University

Hans LingforsGP, GP, MD, Primary Care Research and Development Unit, Futhrum, Jönköping County