特定保健指導の評価（1）：国保データを用いた積極的支援と動機づけ支援の比較

Objectives: The Health Checkups and Healthcare Advice with Particular Focus on Metabolic Syndrome (Tokutei Kenshin Hokenshido) started in 2008. In this study, we examined the effects of healthcare advice with attention to the difference in effect according to the level of advice. Methods: We used data from insured individuals who received health checkups in 2008 and 2009, and healthcare advice in 2008 under the National Health Insurance system, in all municipalities in Yamaguchi prefecture. The numbers of subjects were 155 for intensive advice (Sekkyokuteki) and 735 for moderate advice (Doukizuke). We compared the changes in the results of health checkups according to the level of advice, and examined the effect adjusted for sex, age, and baseline data of health checkups in 2008. Results: Other than systolic blood pressure and hemoglobin A1c, all items showed a significant improvement in all the subjects. The improvements in body weight, BMI, waist circumstance, and HDL-cholesterol in subjects who received intensive advice were significantly larger than those in subjects who received moderate advice. However, among the subjects under 65 years old, only waist circumstance and FBS showed a significant difference between intensive and moderate advices. After adjustment for sex, age, and baseline data, there was no relationship between the level of advice and the change in results of health checkups. Conclusions: Although our findings are not conclusive and further studies are required, they suggest that the effects of intensive and moderate advice are not significantly different. In addition to improving the effect of healthcare advice, a rethinking of provision of healthcare advice is essential: moderate advice might be more appropriate considering the limited resources and budget in communities.