title: The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial.
abstract: BACKGROUND
  To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm).
  
  
  METHODS
  This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36.
  
  
  RESULTS
  Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended).
  
  
  CONCLUSIONS
  Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn.
  
  
  BACKGROUND
  National Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370.
authors.affiliation: Eli Lilly (M) Sdn Bhd, Cameron Highlands, Petaling Jaya, Malaysia. Jude_selvaraj@yahoo.com
authors.forename: Francis Jude
authors.initials: FJ
authors.lastname: Selvaraj
authors.forename: Mafauzy
authors.initials: M
authors.lastname: Mohamed
authors.forename: Khairani
authors.initials: K
authors.lastname: Omar
authors.forename: Sudha
authors.initials: S
authors.lastname: Nanthan
authors.forename: Zainab
authors.initials: Z
authors.lastname: Kusiar
authors.forename: Selvaraj Y
authors.initials: SY
authors.lastname: Subramaniam
authors.forename: Norsiah
authors.initials: N
authors.lastname: Ali
authors.forename: Kamalakaran
authors.initials: K
authors.lastname: Karanakaran
authors.forename: Fauziah
authors.initials: F
authors.lastname: Ahmad
authors.forename: Wilson H H
authors.initials: WH
authors.lastname: Low
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D019468:Disease Management; D050171:Dyslipidemias / Q000628:therapy*; D005260:Female; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides