title: Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial.
abstract: BACKGROUND
  Cardiovascular disease accounts for a large burden of disease, but is amenable to prevention through lifestyle modification. This paper examines patient and practice predictors of referral to a lifestyle modification program (LMP) offered as part of a cluster randomised controlled trial (RCT) of prevention of vascular disease in primary care.
  
  
  METHODS
  Data from the intervention arm of a cluster RCT which recruited 36 practices through two rural and three urban primary care organisations were used. In each practice, 160 eligible high risk patients were invited to participate. Practices were randomly allocated to intervention or control groups. Intervention practice staff were trained in screening, motivational interviewing and counselling and encouraged to refer high risk patients to a LMP involving individual and group sessions. Data include patient surveys; clinical audit; practice survey on capacity for preventive care; referral records from the LMP. Predictors of referral were examined using multi-level logistic regression modelling after adjustment for confounding factors.
  
  
  RESULTS
  Of 301 eligible patients, 190 (63.1%) were referred to the LMP. Independent predictors of referral were baseline BMI ≥ 25 (OR 2.87 95%CI:1.10, 7.47), physical inactivity (OR 2.90 95%CI:1.36,6.14), contemplation/preparation/action stage of change for physical activity (OR 2.75 95%CI:1.07, 7.03), rural location (OR 12.50 95%CI:1.43, 109.7) and smaller practice size (1-3 GPs) (OR 16.05 95%CI:2.74, 94.24).
  
  
  CONCLUSIONS
  Providing a well-structured evidence-based lifestyle intervention, free of charge to patients, with coordination and support for referral processes resulted in over 60% of participating high risk patients being referred for disease prevention. Contrary to expectations, referrals were more frequent from rural and smaller practices suggesting that these practices may be more ready to engage with these programs.
  
  
  BACKGROUND
  ACTRN12607000423415.
authors.affiliation: University of Sydney, Lismore, Australia. megan.passey@ucrh.edu.au
authors.forename: Megan E
authors.initials: ME
authors.lastname: Passey
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Laws
authors.forename: Upali W
authors.initials: UW
authors.lastname: Jayasinghe
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Fanaian
authors.forename: Suzanne
authors.initials: S
authors.lastname: McKenzie
authors.forename: Gawaine
authors.initials: G
authors.lastname: Powell-Davies
authors.forename: David
authors.initials: D
authors.lastname: Lyle
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000628:therapy; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011237:Predictive Value of Tests; D011314:Preventive Health Services / Q000379:methods; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014652:Vascular Diseases / Q000517:prevention & control*