title: A randomized trial of effects of health risk appraisal combined with group sessions or home visits on preventive behaviors in older adults.
abstract: BACKGROUND
  To explore effects of a health risk appraisal for older people (HRA-O) program with reinforcement, we conducted a randomized controlled trial in 21 general practices in Hamburg, Germany.
  
  
  METHODS
  Overall, 2,580 older patients of 14 general practitioners trained in reinforcing recommendations related to HRA-O-identified risk factors were randomized into intervention (n = 878) and control (n = 1,702) groups. Patients (n = 746) of seven additional matched general practitioners who did not receive this training served as a comparison group. Patients allocated to the intervention group, and their general practitioners, received computer-tailored written recommendations, and patients were offered the choice between interdisciplinary group sessions (geriatrician, physiotherapist, social worker, and nutritionist) and home visits (nurse).
  
  
  RESULTS
  Among the intervention group, 580 (66%) persons made use of personal reinforcement (group sessions: 503 [87%], home visits: 77 [13%]). At 1-year follow-up, persons in the intervention group had higher use of preventive services (eg, influenza vaccinations, adjusted odds ratio 1.7; 95% confidence interval 1.4-2.1) and more favorable health behavior (eg, high fruit/fiber intake, odds ratio 2.0; 95% confidence interval 1.6-2.6), as compared with controls. Comparisons between intervention and comparison group data revealed similar effects, suggesting that physician training alone had no effect. Subgroup analyses indicated favorable effects for HRA-O with personal reinforcement, but not for HRA-O without reinforcement.
  
  
  CONCLUSIONS
  HRA-O combined with physician training and personal reinforcement had favorable effects on preventive care use and health behavior.
authors.affiliation: Albertinen-Haus Geriatrics Center, Scientific Department at the University of Hamburg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Dapp
authors.forename: Jennifer A M
authors.initials: JA
authors.lastname: Anders
authors.forename: Wolfgang
authors.initials: W
authors.lastname: von Renteln-Kruse
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Minder
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Meier-Baumgartner
authors.forename: Cameron G
authors.initials: CG
authors.lastname: Swift
authors.forename: Gerhard
authors.initials: G
authors.lastname: Gillmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: John C
authors.initials: JC
authors.lastname: Beck
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
mesh_terms: D000368:Aged; D005858:Germany; D006126:Group Processes; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006299:Health Services for the Aged; D006305:Health Status Indicators; D006792:House Calls; D006801:Humans; D010348:Patient Care Team; D011314:Preventive Health Services; D012054:Reinforcement, Psychology