ABSTRACT

The aims of this PhD dissertation were to analyse the effect of preventive health screenings and health discussions on contacts to general practice and contacts to hospitals and to analyse if selfrated health (SRH) and other self-reported risk factors can predict future consultations in general practice and hospital admissions. The studies included in this dissertation are based upon a randomised controlled trial in general practice concerning health screening and health discussions: the Ebeltoft Health Promotion Project.

All middle-aged residents registered with a general practitioner in the district of Ebeltoft, Denmark, were included (n=3464). A random sample of 2030 subjects was selected for invitation. Persons accepting participation were randomly divided into one internal control group and two intervention groups. One intervention group was during the five years offered three health screenings. The other intervention group was in addition offered a yearly health discussion with their general practitioner.

Invitation to participate in preventive health screenings and health discussions in the present trial did not change the number of contacts to general practice or hospital over a period of eight years compared with no invitation. Similar there were no overall differences between persons who received questionnaires alone compared with those who participated in general health screenings or discussions concerning contacts to hospital or general practice, except for daytime consultations, where the discussion group saw a significant increase in rate ratios over six years compared with the questionnaire group. Investigation of annual rate ratios for daytime consultations in general practice showed a significant trend with the ratios gradually decreasing from 1992 to 1999 among invited compared with non-invited subjects. Investigation of annual rate ratios for hospital admissions showed a highly significant trend with a lower rate in the invited group and the intervention groups four to five years after intervention was launched. Thus, health screening of the middle-aged population in general practice may have a long-term decreasing effect on health care contacts.

Concerning baseline individual risk factors, overweight and both high and no alcohol were associated with more daytime consultations in general practice. Baseline SRH was a predictor for daytime consultations, where moderate and worse SRH was associated with an increase in consultations. Low SRH was found to be a predictor for hospitalisations in absence of smoking and alcohol intake. When performing health screenings for the middle-aged population, persons with low SRH should be viewed as a special group with a high risk of future morbidity as indicated by an increased number of health care contacts.