CMAJ • December 8, 2009; 181 (12). First published November 30, 2009; doi:10.1503/cmaj.081591
© 2009 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online Appendices
Right arrow All Versions of this Article:
cmaj.081591v1
181/12/E267    most recent
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Koelewijn-van Loon, M. S.
Right arrow Articles by Grol, R.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Koelewijn-van Loon, M. S.
Right arrow Articles by Grol, R.
Related Collections
Right arrowRelated Article

Research

Involving patients in cardiovascular risk management with nurse-led clinics: a cluster randomized controlled trial

Marije S. Koelewijn-van Loon, MSc, Trudy van der Weijden, PhD MD, Ben van Steenkiste, PhD, Gaby Ronda, PhD, Bjorn Winkens, PhD, Johan L. Severens, PhD, Michel Wensing, PhD, Glyn Elwyn, PhD and Richard Grol, PhD

From the CAPHRI School for Public Health and Primary Care, Departments of General Practice (Koelewijn-van Loon, van der Weijden, van Steenkiste, Ronda, Grol), Health Organisation, Policy and Economics (Severens) and Methodology and Statistics (Winkens), Maastricht University, Maastricht, the Netherlands; the Department of Epidemiology and Medical Technology assessment (Severens), University Hospital Maastricht, Maastricht, the Netherlands; the Scientific Institute for Quality of HealthCare (van der Weijden, Wensing, Elwyn, Grol), Nijmegen, Radboud University Nijmegen, the Netherlands; and the Department of Primary Care and Public Health (Elwyn), School of Medicine, Cardiff University, Cardiff, UK

Correspondence to: Marije S. Koelewijn-van Loon, Maastricht University, CAPHRI School for Public Health and Primary Care, Department of General Practice, PO Box 616, 6200 MD Maastricht, the Netherlands; M.Koelewijn{at}HAG.unimaas.nl

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.

Interpretation: 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.


Related Article

Highlights
Can. Med. Assoc. J. 2009 181: 873. [Full Text] [PDF]



eLetters:

Read all eLetters

Without CAD Inherited Real Risk, All Environmental Risk Factors of CAD are innocent Bystanders.
Sergio Stagnaro
CMAJ, 14 Dec 2009 [Full text]