Effects of a general practice-based intervention on diet, body mass index and blood lipids in patients at cardiovascular risk

Background: General practice-based health-promotion programmes implemented by nurse-counsellors may reduce cardiovascular risk factors, particularly in patients at increased risk.Design: In a randomized controlled trial, trained nurse-counsellors delivered cognitive behavioural programmes aiming to reduce cardiovascular risk in patients with hypertension, Type 2 diabetes mellitus or coronary heart disease. Of 591 eligible patients from seven general practices in Perth, Western Australia, 212 agreed to participate and were randomized to one of three groups. In the 'Low' intervention (n = 69), monthly telephone contacts for 1 year followed one face-to-face individual counselling session; in the 'High' intervention (n = 74) individual face-to-face counselling continued over 1 year, taking place monthly, for up to 1 h; Controls (n = 69) received usual care only. Participants were assessed at baseline with follow-up 12 and 18 months later.Results: Follow-up assessments were attended by 77, 71 and 65% of the Control, 'Low' and 'High' groups, respectively. Total fat intake fell by 9, 12 and 5% in the 'High', 'Low' and Control groups, respectively, at 12 months and by 2, 10 and 5% at 18 months. Total serum cholesterol fell by 3, 3 and 2% in the 'High', 'Low' and 'Control' groups, respectively, at 12 months and by 7, 5 and 8% at 18 months. Neither change in fat intake nor serum cholesterol differed significantly between groups. Body mass index increased in all groups with no significant changes related to the programme.Conclusions: Programmes using nurse-counsellors were not significantly more successful than usual care from general practitioners, consistent with reported benefits of lifestyle advice from primary-care physicians.