Randell Elizabeth, Pickles Timothy, Simpson Sharon A, Spanou Clio, McCambridge Jim, Hood Kerenza, Butler Christopher C
South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
MRC/CSO SPHSU, 200 Renfield Street, Glasgow, G2 3QB, UK.
BMC Fam Pract. 2015 Oct 9;16:133. doi: 10.1186/s12875-015-0359-x.
Smoking, excessive drinking, lack of exercise and a poor diet remain key causes of premature morbidity and mortality globally, yet it is not clear what proportion of patients attending for routine primary care are eligible for interventions about these behaviours, the extent to which they co-occur within individuals, and which individuals are at greatest risk for multiple unhealthy behaviours. The aim of the trial was to examine 'intervention eligibility' and co-occurrence of the 'big four' risky health behaviours - lack of exercise, smoking, an unhealthy diet and excessive drinking - in a primary care population.
Data were collected from adult patients consulting routinely in general practice across South Wales as part of the Pre-Empt study; a cluster randomised controlled trial. After giving consent, participants completed screening instruments, which included the following to assess eligibility for an intervention based on set thresholds: AUDIT-C (for alcohol), HSI (for smoking), IPAQ (for exercise) and a subset of DINE (for diet). The intervention following screening was based on which combination of risky behaviours the patient had. Descriptive statistics, χ2 tests for association and ordinal regressions were undertaken.
Two thousand sixty seven patients were screened: mean age of 48.6 years, 61.9 % female and 42.8 % in a managerial or professional occupation. In terms of numbers of risky behaviours screened eligible for, two was the most common (43.6 %), with diet and exercise (27.2 %) being the most common combination. Insufficient exercise was the most common single risky behaviour (12.0 %). 21.8 % of patients would have been eligible for an intervention for three behaviours and 5.9 % for all four behaviours. Just 4.5 % of patients did not identify any risky behaviours. Women, older age groups and those in managerial or professional occupations were more likely to exhibit all four risky behaviours.
Very few patients consulting for routine primary care screen ineligible for interventions about common unhealthy behaviours, and most engage in more than one of the major common unhealthy behaviours. Clinicians should be particularly alert to opportunities to engaging younger, non professional men and those with multi-morbidity about risky health behaviour.
ISRCTN22495456.
吸烟、过度饮酒、缺乏运动和不良饮食仍然是全球过早发病和死亡的主要原因，但尚不清楚在接受常规初级保健的患者中，有多大比例的人适合接受针对这些行为的干预措施，这些行为在个体中同时出现的程度，以及哪些个体面临多种不健康行为的风险最大。该试验的目的是在初级保健人群中研究“干预资格”以及“四大”危险健康行为（缺乏运动、吸烟、不良饮食和过度饮酒）的同时出现情况。
作为“先发制人”研究的一部分，收集了南威尔士全科医疗中常规就诊的成年患者的数据；这是一项整群随机对照试验。在获得同意后，参与者完成了筛查工具，其中包括以下内容，以根据设定的阈值评估干预资格：AUDIT-C（用于评估酒精）、HSI（用于评估吸烟）、IPAQ（用于评估运动）和DINE的一个子集（用于评估饮食）。筛查后的干预措施基于患者存在的危险行为组合。进行了描述性统计、关联的χ²检验和有序回归分析。
共筛查了267名患者：平均年龄48.6岁，61.9%为女性，42.8%从事管理或专业职业。就筛查出符合干预资格的危险行为数量而言，两种行为最为常见（43.6%），饮食和运动（占27.2%）是最常见的组合。运动不足是最常见的单一危险行为（12.0%）。21.8%的患者符合三项行为干预的资格，5.9%的患者符合四项行为干预的资格。只有4.5%的患者未发现任何危险行为。女性、年龄较大的人群以及从事管理或专业职业的人更有可能表现出所有四项危险行为。
在接受常规初级保健咨询的患者中，很少有人筛查出不符合针对常见不健康行为进行干预的条件，而且大多数人存在不止一种主要的常见不健康行为。临床医生应特别关注针对年轻、非专业男性以及患有多种疾病的人群开展危险健康行为干预的机会。
ISRCTN22495456
