Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University.
Amagasaki City Office.
J Epidemiol. 2020 Apr 5;30(4):194-199. doi: 10.2188/jea.JE20180194. Epub 2019 Apr 13.
It is uncertain whether health counselling after community-based health checkups for high-risk individuals of lifestyle-related disease enhances their referral to physicians.
We performed a clustered randomized controlled trial of untreated high-risk individuals aged 40 to 74 years who were screened from the annual health checkup in 2014 and 2015 under the national health insurance in 43 municipalities around Japan, assigning 21 intervention and 22 usual care municipalities. The high-risk conditions were severe forms of hypertension, diabetes, dyslipidemia (for men), and proteinuria. For the intervention group, the theory-based health counselling was performed to enhance referrals to physicians, while each municipality performed its own standard counselling for the usual care group. Data on clinical visits and risk factors were collected systematically and anonymously from the databases of health insurance qualification, health insurance claims, and annual health checkups. Hypotheses are that the cumulative proportion of seeing physicians (clinical visits) is higher in the intervention than the usual care groups, and that those in the intervention group have lower cumulative incidence of composite outcomes associated with lifestyle-related diseases.
The numbers of subjects for the analyses were 8,977 in the intervention group and 6,733 in the usual care group. Among them, 6,758 had hypertension, 2,147 had diabetes, 2,861 had dyslipidemia, and 1,221 had proteinuria in the intervention group, with corresponding numbers of 4,833, 1,517, 2,262, and 845, respectively, in the usual care group. There were no material differences in mean levels and proportions of major cardiovascular risk factors between the two groups.
We expect to provide scientific evidence on the effectiveness of health counselling.
目前尚不确定对生活方式相关疾病高危人群进行社区健康检查后提供健康咨询是否会增加他们向医生就诊的比例。
我们对未接受治疗的年龄在 40 至 74 岁之间的高危人群进行了一项基于群组的随机对照试验，这些高危人群是从日本各地 43 个市町村的国民健康保险年度体检中筛选出来的，将 21 个干预市町村和 22 个常规护理市町村进行了分组。高危情况包括严重高血压、糖尿病、血脂异常（男性）和蛋白尿。对于干预组，采用基于理论的健康咨询来促进向医生就诊，而常规护理组的每个市町村则自行提供标准咨询。临床就诊和危险因素的数据从健康保险资格、健康保险索赔和年度体检的数据库中系统且匿名收集。假设干预组的就诊（临床就诊）累积比例高于常规护理组，且干预组与生活方式相关疾病相关的复合结局的累积发生率更低。
干预组和常规护理组的分析对象人数分别为 8977 人和 6733 人。其中，干预组 6758 人患有高血压，2147 人患有糖尿病，2861 人患有血脂异常，1221 人患有蛋白尿，相应的数字在常规护理组中分别为 4833、1517、2262 和 845。两组之间主要心血管危险因素的平均水平和比例没有明显差异。
我们希望为健康咨询的有效性提供科学证据。
