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Am J Manag Care. 2009 Apr;15(4):255-62.

Primary care strength linked to prevention programs for cardiovascular disease.

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Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands.



Primary care plays a central role in the prevention and management of cardiovascular disease. We expected that countries with strong primary care systems would have programs to improve management of disease, but wondered how they dealt with lifestyle interventions delivered in primary care.


Observational comparative study.


Using country coordinators and key informants, we collected information on 42 programs to improve cardiovascular risk management in 11 countries (Austria, Belgium, Finland, France, Germany, Israel, The Netherlands, Spain, Slovenia, Switzerland, the United Kingdom).


Most (95%) of the improvement programs were targeted at health professionals; 86% of these provided education. Evaluation was part of all programs. In countries with a strong primary care system, 63% of the programs focused exclusively on disease management, 29% on lifestyle interventions, and 8% on both. In countries with a weak primary care system, 22% of the programs focused on disease management and 78% on lifestyle improvement.


Our findings suggest that a strong primary care system is likely to make efforts to improve disease management, but not necessarily efforts to improve delivery of lifestyle interventions. This may be a missed opportunity, given the potential of primary care to influence lifestyle.

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