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What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group.

Král, N., Waard, A.M. de, Schellevis, F.G., Korevaar, J.C., Lionis, C., Carlsson, A.C., Sønderlund, A.L., Søndergaard, J., Larsen, L.B., Hollander, M., Thilsing, T., Angelaki, A., Wit, N.J. de, Seifert, B. What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group. European Journal of General Practice: 2019, 25(3), 101-108
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Background
Selective prevention of cardiometabolic diseases (CMD)-that is, preventive measures specifically targeting the high-risk population-may represent the most effective approach for mitigating rising CMD rates.

Objectives
To develop a universal concept of selective CMD prevention that can guide implementation within European primary care.

Methods
Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round.

Results
In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated.

Conclusion
The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.