title: A primary care cardiovascular risk reduction clinic in Canada was more effective and no more expensive than usual on-demand primary care--a randomised controlled trial.
abstract: The objective of this randomised controlled trial was to compare the effects and expense of three approaches to care (1) proactive cardiovascular risk reduction (CaRR) clinic; (2) nurse telephone calls; or (3) usual care for people with cardiovascular risk factors in a Primary Care, Health Service Organisation (HSO) in Ontario, Canada. Subjects included consenting patients with an identified cardiovascular disease (CVD) risk factor identified from the HSO computerised patient information system in 2004. Patients were excluded if they were mentally incompetent, <18 years of age, in a nursing home, or not English speaking. Of 1570 eligible subjects, 523 (33.3%) verbally declined, 145 (9.2%) could not be contacted, and 249 (15.9%) were not needed. The final sample size was 653 (41.6%), 634 completed the follow-up (97%). The Cardiovascular Risk Score, Health and Social Service Utilisation, Montgomery-Asberg Depression Rating, Billings and Moos Indices of Coping, Personal Resource and Self-Efficacy Questionnaires were measured at baseline and 1-year follow-up by clinical examination and telephone interview. Cardiovascular risk scores were reduced in all treatment groups after 1 year. The proportions of subjects showing reduction in risk score greater than or equal to 10% was greatest in the CaRR group (69.2%) compared with Nurse Phone intervention (57.8%) and Usual Care (59.0%) (M-Hchi(2) = 4.33, df = 1, P = 0.037, CaRR-Usual Care). Self-efficacy scores showed the greatest improvements in the CaRR clinic. This effect was achieved with no significant difference in total person per annum costs for direct and indirect health and social service utilisation between all three groups. A CaRR clinic is more effective in reducing CVD risk after 1 year compared with nurse phone intervention and usual care with no additional expense found.
authors.affiliation: Caroline Medical Group, ystem-Linked Research Unit on Health and Social Service Utilisation, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Mills
authors.forename: Patricia
authors.initials: P
authors.lastname: Loney
authors.forename: Ellen
authors.initials: E
authors.lastname: Jamieson
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Gina
authors.initials: G
authors.lastname: Browne
authors.forename: Barbara
authors.initials: B
authors.lastname: Bell
authors.forename: Lori
authors.initials: L
authors.lastname: Chalklin
authors.forename: Jim
authors.initials: J
authors.lastname: Kraemer
authors.forename: David
authors.initials: D
authors.lastname: Wallik
authors.forename: Chris
authors.initials: C
authors.lastname: Williams
authors.forename: Stephen
authors.initials: S
authors.lastname: Duncan
mesh_terms: D000368:Aged; D002170:Canada; D002318:Cardiovascular Diseases / Q000523:psychology / Q000628:therapy*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010353:Patient Education as Topic / Q000379:methods / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020377:Self Efficacy; D012959:Socioeconomic Factors; D013689:Telephone / Q000706:statistics & numerical data