title: Intensified preventive care to reduce cardiovascular risk in healthcare centres located in deprived neighbourhoods: a randomized controlled trial.
abstract: BACKGROUND
  We examined the effectiveness of a structured collaboration in general practice between a practice nurse, a peer health educator, the general practitioner (GP) and a GP assistant in providing intensified preventive care for patients at high risk of developing cardiovascular diseases.
  
  
  METHODS
  A randomized controlled trial in three healthcare centres (18 GPs) in deprived neighbourhoods of two major Dutch cities.
  
  
  METHODS
  Two hundred seventy-five high-risk patients (30-70 years) from various ethnic groups were randomized to intervention (n=137) or usual care group (n=138). We determined group differences in outcomes [10-year absolute risk (Framingham risk equation), blood pressure, lipids and body mass index] at 12-month follow-up.
  
  
  RESULTS
  The 10-year absolute risk was reduced by 1.76% (standard error: 0.81) in intervention and by 2.27% (standard error: 0.69) in usual care group; the difference in mean change was 0.88% [95% confidence interval: -1.16 to 2.93]. In both groups significant reductions were observed in the following individual risk factors: total cholesterol, total cholesterol/high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, with no relevance between group differences.
  
  
  CONCLUSIONS
  The cardiovascular risk profile of intervention and control patients improved after 1-year follow-up. However, no extra effect of the structured preventive care on the risk for cardiovascular diseases was achieved.
authors.affiliation: Department of Health Policy and Management, Erasmus Medical Centre, Rotterdam, The Netherlands. fatima.el.fakiri@rivm.nl
authors.forename: Fatima
authors.initials: F
authors.lastname: El Fakiri
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bruijnzeels
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: Uitewaal
authors.forename: Rianne A A
authors.initials: RA
authors.lastname: Frenken
authors.forename: Marc
authors.initials: M
authors.lastname: Berg
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003151:Community Health Centers; D005194:Family Practice; D005260:Female; D040441:Health Educators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009743:Nursing, Practical; D011204:Poverty Areas; D011314:Preventive Health Services; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior