Digital stepwise approach to indicated prevention of chronic diseases in the Danish primary care sector

Context
Stepwise approaches to prevention of chronic diseases where only those at high risk attend for a health check seem to be the way forward. We developed a purely digital approach to invite, risk assess, risk stratify and provide feedback to patients registered at their general practitioner (GP). This presentation reports on the uptake of that intervention.
Methods
A cross-sectional analysis of determinants of uptake.
Intervention
Invitations were sent to the patient’s digital mailbox. Consent, risk assessment, stratification and feedback were provided on a secure webpage. Risk assessment was based on questionnaire, risk scores and specific information from the GPs electronic patient record system. Each patient was stratified to one of four groups: already known, high risk, moderate risk and low risk and given individualized recommendations. Patients at high risk were recommended to consult their GP. Patients at moderate risk were recommended to consult the community health services.
Results
A total of 8814 patients age 29 to 60 were included, 2661 received a feedback. Of these 22% were at high risk, 23% at moderate risk. Around 20% of those at high or moderate risk attended a health check. Higher uptake was associated with higher socio-economic status (SES), being woman and at higher age. However, lower self-efficacy and self-rated health were associated with higher uptake of the health check.
Conclusions
A digital approach to stepwise prevention of chronic disease is suitable for those at high SES, however digital feedback may help those who would not otherwise take up health checks.