RHP&EO is the electronic journal of the International Union for Health Promotion and Education

Effectiveness Of Two Preventive Interventions For Coronary Disease Risk In Primary Care

Eivind Meland, Even Laerum, Rune J Ulvik

Department of Public Health and Primary Health Care, Division C or General Practice, University of Bergen, Ulriksdal 8c, 5009, Bergen Norway

Purpose. 1. To compare a patient centred, self directive intervention with conventional care; 2. To evaluate longitudinal within-group-changes of coronary heart disease risk.

Methods. Risk factor changes were evaluated in 110 men with high coronary heart disease risk attending a one year intervention study in general practice. The 22 participating general practice centres were randomly allocated to follow either a patient centred, self directive intervention or a conventional approach.

Results. No significant between-group-differences were found in any single risk factor or in the combined risk of coronary heart disease. The improvement of total risk from screening time to conclusion of the study corresponded with changes of relative risks of coronary heart disease to 0.64 (95% CI: 0.54-0.77) and 0.65 (0.54-0.77) in the patient centred, self directive and the conventional care group respectively (p<0.0001 in both groups).

Discussion. In the present study no significant between-group differences were found in any single risk factor or in the combined risk of CHD. A borderline significant BP difference was revealed, but the groups were slightly different at the start of the study.

The longitudinal within-group-changes of total CHD risk we statistically significant in both groups. Caution should, however, be used when interpreting such changes as they contain regressional effects as well as interventional effects.

We conclude that although the longitudinal CHD risk improvement in the present study may partly be attributed to regressional effects, the CHD risk changes seem clinically relevant. These changes can be achieved by simple clinical methods provided a structured follow-up of patients. The ever} day GP clinical work seems as efficacious as a spesific intervention method based on currently advocated behaviour change principles, although we cannot rule out that a more extensive education of participating doctors could have improved the outcome. If the high risk, clinical strategy is intended, the clinician should direct her/his attention to the population at the highest distribution of total CHD risk.

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