Population segmentation for the management of preventive services in adults
DOI:
https://doi.org/10.5281/zenodo.22293877Keywords:
health services management, population segmentation, health services planningAbstract
The management of preventive services requires classifying potential demand according to the intensity of the organizational response. In this context, the present study aimed to determine the preventive service management modality through population segmentation based on physical activity and cardiovascular risk criteria in adults aged 45 to 59 years in Huánuco, Peru, during 2024. To this end, a quantitative, observational, analytical, and cross-sectional study was conducted with 381 adults selected through probabilistic sampling. The main variable was the preventive management modality, categorized as intensive intervention, focused intervention, or preventive maintenance using an exploratory operational rule. Physical activity and cardiovascular risk served as technical segmentation criteria; their ordinal association was evaluated as a complementary analysis using Kendall's tau-c. Regarding the results, the intensive modality comprised 42.3% of the participants, the focused modality 27.3%, and preventive maintenance 30.4%. As additional findings, physical activity was low in 39.1% of participants, and 38.3% presented high, very high, or critical risk; both criteria showed an inverse association (tau-c = −0.591; p < 0.001). In conclusion, segmentation allowed for estimating the distribution of demand according to management intensity and offers a preliminary tool for organizing recruitment, counseling, and follow-up. However, it must be validated before being used as an institutional protocol or clinical criterion.
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Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington de Gonzalez, A., Visvanathan, K., Campbell, P. T., Freedman, M., Weiderpass, E., Adami, H.-O., Linet, M. S., Lee, I.-M., & Matthews, C. E. (2015). Leisure time physical activity and mortality: A detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine, 175(6), 959–967. https://doi.org/10.1001/jamainternmed.2015.0533
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C., Jr., Virani, S. S., Williams, K. A., Sr., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), e596–e646. https://doi.org/10.1161/CIR.0000000000000678
Bakker, E. A., Lee, D.-C., Hopman, M. T. E., Oymans, E. J., Watson, P. M., Thompson, P. D., Thijssen, D. H. J., & Eijsvogels, T. M. H. (2021). Dose–response association between moderate to vigorous physical activity and incident morbidity and mortality for individuals with a different cardiovascular health status: A cohort study among 142,493 adults from the Netherlands. PLOS Medicine, 18(12), e1003845. https://doi.org/10.1371/journal.pmed.1003845
Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J. F., & Martin, B. W. (2012). Correlates of physical activity: Why are some people physically active and others not? The Lancet, 380(9838), 258–271. https://doi.org/10.1016/S0140-6736(12)60735-1
Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta-analysis. Annals of Internal Medicine, 162(2), 123–132. https://doi.org/10.7326/M14-1651
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955
Chong, J. L., Lim, K. K., & Matchar, D. B. (2019). Population segmentation based on healthcare needs: A systematic review. Systematic Reviews, 8, 202. https://doi.org/10.1186/s13643-019-1105-6
Craig, C. L., Marshall, A. L., Sjöström, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., Pratt, M., Ekelund, U., Yngve, A., Sallis, J. F., & Oja, P. (2003). International Physical Activity Questionnaire: 12-country reliability and validity. Medicine & Science in Sports & Exercise, 35(8), 1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB
Ekelund, U., Steene-Johannessen, J., Brown, W. J., Fagerland, M. W., Owen, N., Powell, K. E., Bauman, A., & Lee, I.-M. (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet, 388(10051), 1302–1310. https://doi.org/10.1016/S0140-6736(16)30370-1
Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H., Jefferis, B., Fagerland, M. W., Whincup, P., Diaz, K. M., Hooker, S. P., Chernofsky, A., Larson, M. G., Spartano, N., Vasan, R. S., Dohrn, I.-M., Hagströmer, M., Edwardson, C., Yates, T., Shiroma, E. J., Anderssen, S. A., & Lee, I.-M. (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all-cause mortality: Systematic review and harmonised meta-analysis. BMJ, 366, l4570. https://doi.org/10.1136/bmj.l4570
Kaptoge, S., Pennells, L., De Bacquer, D., Cooney, M. T., Kavousi, M., Stevens, G., Riley, L. M., Savin, S., Khan, T., Altay, S., Amouyel, P., Assmann, G., Bell, S., Ben-Shlomo, Y., Berkman, L., Beulens, J. W., Björkelund, C., Blaha, M., Blazer, D. G., … Di Angelantonio, E. (2019). World Health Organization cardiovascular disease risk charts: Revised models to estimate risk in 21 global regions. The Lancet Global Health, 7(10), e1332–e1345. https://doi.org/10.1016/S2214-109X(19)30318-3
Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., Veerman, J. L., Delwiche, K., Iannarone, M. L., Moyer, M. L., Cercy, K., Vos, T., Murray, C. J. L., & Forouzanfar, M. H. (2016). Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: Systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ, 354, i3857. https://doi.org/10.1136/bmj.i3857
Lear, S. A., Hu, W., Rangarajan, S., Gasevic, D., Leong, D., Iqbal, R., Casanova, A., Swaminathan, S., Anjana, R. M., Kumar, R., Rosengren, A., Wei, L., Yang, W., Chuangshi, W., Huaxing, L., Nair, S., Diaz, R., Swidon, H., Gupta, R., … Yusuf, S. (2017). The effect of physical activity on mortality and cardiovascular disease in 130,000 people from 17 high-income, middle-income, and low-income countries: The PURE study. The Lancet, 390(10113), 2643–2654. https://doi.org/10.1016/S0140-6736(17)31634-3
Li, J., & Siegrist, J. (2012). Physical activity and risk of cardiovascular disease—A meta-analysis of prospective cohort studies. International Journal of Environmental Research and Public Health, 9(2), 391–407. https://doi.org/10.3390/ijerph9020391
Lynn, J., Straube, B. M., Bell, K. M., Jencks, S. F., & Kambic, R. T. (2007). Using population segmentation to provide better health care for all: The “Bridges to Health” model. The Milbank Quarterly, 85(2), 185–208. https://doi.org/10.1111/j.1468-0009.2007.00483.x
Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., Urbina, E. M., Viera, A. J., White, W. B., Wright, J. T., Jr., & on behalf of the American Heart Association Council on Hypertension. (2019). Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Hypertension, 73(5), e35–e66. https://doi.org/10.1161/HYP.0000000000000087
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The Physical Activity Guidelines for Americans. JAMA, 320(19), 2020–2028. https://doi.org/10.1001/jama.2018.14854
Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., III, Haskell, W., & Lee, I.-M. (2011). Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation, 124(7), 789–795. https://doi.org/10.1161/CIRCULATIONAHA.110.010710
Sember, V., Meh, K., Sorić, M., Starc, G., Rocha, P., & Jurak, G. (2020). Validity and reliability of International Physical Activity Questionnaires for adults across EU countries: Systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(19), 7161. https://doi.org/10.3390/ijerph17197161
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334–1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.-M., Capodanno, D., Cosyns, B., Crawford, C., Davos, C. H., Desormais, I., Di Angelantonio, E., Franco, O. H., Halvorsen, S., Hobbs, F. D. R., Hollander, M., … Williams, B. (2021). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal, 42(34), 3227–3337. https://doi.org/10.1093/eurheartj/ehab484
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
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