Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial.
BACKGROUND
It is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care.


METHODS
A multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines.


RESULTS
107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference -MD- = -19.60; 95 % CI: -15.33 at -23.87 mg/dl; p < 0.001), LDL-cholesterol levels (MD = -13.78; 95 % CI: -9.77 at -17.79 mg/dl; p < 0.001) and triglycerides (MD = -19.14; CI 95 %: -11.29 at -26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95 % CI: 1.67-19.91).


CONCLUSIONS
A Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise.


BACKGROUND
the trial is registered in ClinicalTrials.gov ( NCT01282190 ; January 21, 2011).
Primary Care Center Colmeiro, Vigo, Spain. jboveda1@gmail.com.
Julia
J
Bóveda-Fontán
CAP Vallcarca, Barcelona, Spain. nieves.barragan@gmail.com.
Nieves
N
Barragán-Brun
CAP Vallcarca, Barcelona, Spain. manuelcn@camfic.org.
Manuel
M
Campiñez-Navarro
Unidad Docente de Medicina Familiar y Comunitaria de Córdoba. Distrito Sanitario Córdoba y Guadalquivir. C/Isla de Lanzarote, Córdoba, Spain. langel.perula.sspa@juntadeandalucia.es.|Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital/University of Córdoba, Córdoba, Spain. langel.perula.sspa@juntadeandalucia.es.
Luís Ángel
LÁ
Pérula-de Torres
Primary Care Center Encants (Maragall), Barcelona, Spain. boschfontcuberta@gmail.com.
Josep M
JM
Bosch-Fontcuberta
CAP Vallcarca, Barcelona, Spain. rmartin@perevirgili.catsalut.net.
Remedios
R
Martín-Álvarez
Helth Center Errentería, Avda. Galzaraborda 67, Donostia, Spain. juancarlos.arboniesortiz@osakidetza.net.
Juan Carlos
JC
Arbonies-Ortiz
Centro de Saúde A Milagrosa, Lugo, Spain. jnovor@gmail.com.
Jesús Manuel
JM
Novo-Rodríguez
Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain. margarita.criado.exts@juntadeandalucia.es.
Margarita
M
Criado-Larumbe
Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain. joseangelfernandezgarcia@hotmail.com.
Jose Angel
JA
Fernández-García
UGC Fuensanta. Teaching Unit of Family and Community Medicine Cordoba. Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba, Córdoba, Spain. martinriobooenrique@gmail.com.
Enrique
E
Martín-Rioboó
D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D050171:Dyslipidemias / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D010349:Patient Compliance; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D014280:Triglycerides; D002784:Cholesterol