Effectiveness of a check-up for rehabilitation and prevention needs in primary care

Abstract Background General practitioners play a central role in initiating rehabilitation and prevention services. However, systematic screening for rehabilitation and prevention needs has not been carried out in general practices so far. The legislation encourages the implementation and evaluation of so-called ‘check-up 45+’, which target individuals aged 45 and older. The study aims to evaluate the effectiveness of a check-up 45+ in primary care. Methods A pragmatic, randomized controlled trial was conducted in 26 general practices in the German states of Berlin and Brandenburg among patients aged 45 to 59 years (DRKS00028303). The control group (n = 695) received usual care plus a questionnaire on sociodemographic and health-related characteristics. The intervention group (n = 706) completed additionally the 2-page ‘screening 45+’, which captures rehabilitation and prevention needs in five dimensions. After algorithm-based ad hoc evaluation by practice staff, the general practice could modify the recommendation based on available information (e.g., diagnoses, social situation). Information and application documents were provided in case of identified needs. Applications (primary outcome) and approvals (secondary outcome) of rehabilitation and prevention services were recorded using routine data. Results In the intervention group, 64.2% were women, compared to 63.0% in the control group (mean age 52.1 (SD 4.3) and 52.5 (SD 4.4) years). In the intervention group, 85 applications (12.0%) for medical rehabilitation or prevention services were submitted within two months after the study participation, compared to 20 applications (2.9%) in the control group (p < 0.001). The number of approvals for these services was 59 vs. 17 (p < 0.001). Conclusions The application rate for rehabilitation and prevention services was significantly higher in the intervention group compared to the control group, with a relative risk difference by a factor of 4 and an absolute risk difference of 9.1%pt. Key messages • The implementation of a check-up 45+ in primary care leads to a higher rate of applications for rehabilitation and prevention services compared to usual care. • The check-up 45+ may assist general practitioners in systematically identifying rehabilitation and prevention needs of their patients and in applying for these services.