Japan Trial in High-Risk Individuals to Enhance Their Referral to Physicians (J-HARP)—A Nurse-Led, Community-Based Prevention Program of Lifestyle-Related Disease
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- Noguchi Midori
- Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University Amagasaki City Office
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- Kojima Sumi
- Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University Amagasaki City Office
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- Sairenchi Toshimi
- Department of Public Health, Dokkyo Medical University School of Medicine
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- Kinuta Minako
- Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University
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- Yamakawa Miyae
- Department of Health Sciences, Osaka University Graduate School of Medicine
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- Nishizawa Hitoshi
- Department of Metabolic Medicine, Graduate School of Medicine Osaka University
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- Takahara Mitsuyoshi
- Department of Metabolic Medicine, Graduate School of Medicine Osaka University
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- Imano Hironori
- Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University
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- Kitamura Akihiko
- Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University Tokyo Metropolitan Institute of Gerontology
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- Yoshida Toshiko
- School of Nursing, Miyagi University
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- Shintani Ayumi
- Department of Medical Statistics, Graduate School of Medicine Osaka City University
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- Saito Isao
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine
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- Yokoyama Tetsuji
- National Institute of Public Health
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- Shimomura Iichiro
- Department of Health Sciences, Osaka University Graduate School of Medicine
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- Iso Hiroyasu
- Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University
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抄録
<p>Background: It is uncertain whether health counselling after community-based health checkups for high-risk individuals of lifestyle-related disease enhances their referral to physicians.</p><p>Methods: 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.</p><p>Results: 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.</p><p>Conclusions: We expect to provide scientific evidence on the effectiveness of health counselling.</p>
収録刊行物
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- Ｊｏｕｒｎａｌ ｏｆ Ｅｐｉｄｅｍｉｏｌｏｇｙ
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Ｊｏｕｒｎａｌ ｏｆ Ｅｐｉｄｅｍｉｏｌｏｇｙ 30 (4), 194-199, 2020-04-05
日本疫学会