 |
|
Cholesterol-Lowering Intervention ProgramEffect of the Step I Diet in Community Office Practices
Arlene W. Caggiula, PhD;
Joan E. Watson, PhD;
Lewis H. Kuller, MD;
Marian B. Olson, MS;
N. Carole Milas, MS;
Michelle Berry, MS;
Janet Germanowski, MSN
Arch Intern Med. 1996;156(11):1205-1213.
Abstract
Background
A randomized study was conducted to test the feasibility of cholesterol lowering in physician office practices using the National Cholesterol Education Program Adult Treatment Panel I guidelines.
Methods
Twenty-two physician practices in phase 1 and 23 in phase 2 were recruited from communities in Western Pennsylvania and West Virginia. These physicians treated a total of 450 adults in phase 1 (190 men and 260 women) and 480 adults in phase 2 (184 men and 296 women) with hypercholesterolemia. Three models (Usual Care [phase 1], Office Assisted [phase 2], and Nutrition Center [phase 2]) for implementing the National Cholesterol Education Program Adult Treatment Panel I guidelines were tested over an 18-month period. The baseline serum cholesterol levels were as follows: 6.51 mmol/L (252 mg/dL) in the Usual Care Model; 6.80 mmol/L (262 mg/dL) in the Office Assisted Model; and 6.96 mmol/L (269 mg/dL) in the Nutrition Center Model.
Results
In the patients who were not taking lipidlowering medication, the mean cholesterol response was significantly different between the 3 models (P<.01). Serum cholesterol levels declined by 0.14 mmol/L (5.4 mg/dL) in the Usual Care Model; by 0.31 mmol/L (12 mg/dL) in the Office Assisted Model; and by 0.54 mmol/L (20.9 mg/dL) in the Nutrition Center Model. Two factors—length of time to follow-up measurement and change in weight—were independently related to cholesterol response across all models. African Americans demonstrated a significantly smaller response than whites in the Usual Care Model, while men demonstrated greater declines in serum cholesterol levels than women in the Office Assisted Model. Patient satisfaction was very favorable in both enhanced conditions; however, those treated in the the Nutrition Center Model were more satisfied (P<.05) with program components.
Conclusions
The impact of nutrition intervention delivered through physician practices on serum cholesterol levels is less than clinically desirable, and new approaches with more aggressive therapy should be tested and implemented.
(Arch Intern Med. 1996;156:1205-1213)
Author Affiliations
From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa (Drs Caggiula, Watson, and Kuller and Mss Olson, Milas, Berry, and Germanowski), and West Virginia University School of Nursing, Morgantown (Dr Watson).
Footnotes
The 2 primary authors (Drs Caggiula and Watson) are listed alphabetically, as their contribution to the study and to the preparation of the manuscript was equal.
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician
Willaing et al.
European Journal of Cardiovascular Prevention & Rehabilitation 2004;11:513-520.
ABSTRACT
| FULL TEXT
Relative efficacy of differential methods of dietary advice: a systematic review
Thompson et al.
Am J Clin Nutr 2003;77:1052S-1057.
ABSTRACT
| FULL TEXT
REAP and WAVE: New Tools to Rapidly Assess/Discuss Nutrition with Patients
Gans et al.
J. Nutr. 2003;133:556S-562.
ABSTRACT
| FULL TEXT
Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications
Franz et al.
Diabetes Care 2002;25:148-198.
FULL TEXT
Development of a case-based integrated nutrition curriculum for medical students
Hark and Morrison
Am J Clin Nutr 2000;72:890S-897S.
ABSTRACT
| FULL TEXT
Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials1
Anderson et al.
Am J Clin Nutr 2000;71:472-479.
ABSTRACT
| FULL TEXT
Psyllium-Enriched Cereals Lower Blood Total Cholesterol and LDL Cholesterol, but Not HDL Cholesterol, in Hypercholesterolemic Adults: Results of a Meta-Analysis
Olson et al.
J. Nutr. 1997;127:1973-1980.
ABSTRACT
| FULL TEXT
When to Start Cholesterol-Lowering Therapy in Patients With Coronary Heart Disease : A Statement for Healthcare Professionals From the American Heart Association Task Force on Risk Reduction
Grundy et al.
Circulation 1997;95:1683-1685.
FULL TEXT
Nutritional Counseling in Community Office Practices
Ford and Sciamanna
Arch Intern Med 1997;157:361-362.
ABSTRACT
NUTRITION COUNSELING OFTEN INADEQUATE FOR LOWERING CHOLESTEROL
JWatch General 1996;1996:7-7.
FULL TEXT
|
