Involving patients in cardiovascular risk management with nurse-led clinics: a cluster randomized controlled trial.
BACKGROUND
Preventive guidelines on cardiovascular risk management recommend lifestyle changes. Support for lifestyle changes may be a useful task for practice nurses, but the effect of such interventions in primary prevention is not clear. We examined the effect of involving patients in nurse-led cardiovascular risk management on lifestyle adherence and cardiovascular risk.


METHODS
We performed a cluster randomized controlled trial in 25 practices that included 615 patients. The intervention consisted of nurse-led cardiovascular risk management, including risk assessment, risk communication, a decision aid and adapted motivational interviewing. The control group received a minimal nurse-led intervention. The self-reported outcome measures at one year were smoking, alcohol use, diet and physical activity. Nurses assessed 10-year cardiovascular mortality risk after one year.


RESULTS
There were no significant differences between the intervention groups. The effect of the intervention on the consumption of vegetables and physical activity was small, and some differences were only significant for subgroups. The effects of the intervention on the intake of fat, fruit and alcohol and smoking were not significant. We found no effect between the groups for cardiovascular 10-year risk.


CONCLUSIONS
Nurse-led risk communication, use of a decision aid and adapted motivational interviewing did not lead to relevant differences between the groups in terms of lifestyle changes or cardiovascular risk, despite significant within-group differences.
Koelewijn-van Loon
Marije S
MS
CAPHRI School of Public Health and Primary Care, Department of General Practice, Maastricht University, Maastricht, the Netherlands. M.Koelewijn@HAG.unimaas.nl
van der Weijden
Trudy
T
van Steenkiste
Ben
B
Ronda
Gaby
G
Winkens
Bjorn
B
Severens
Johan L
JL
Wensing
Michel
M
Elwyn
Glyn
G
Grol
Richard
R
D000428:Alcohol Drinking / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003376:Counseling; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses'; D012044:Regression Analysis; D012307:Risk Factors; D000074606:Smoking Prevention; D016896:Treatment Outcome