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A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterol.

Abstract

BACKGROUND

Many rural residents do not have access to high-quality nutrition counseling for high blood cholesterol. The objective of this study was to assess the effectiveness of an intervention program designed to facilitate dietary counseling for hypercholesterolemia by rural public health nurses.

METHODS

Eight health departments (216 participants) were randomized to give the special intervention (SI) and nine (252 participants) to give the minimal intervention (MI). The SI consisted of three individual diet counseling sessions given by a public health nurse, using a structured dietary intervention (Food for Heart Program), referral to a nutritionist if lipid goals were not achieved at 3-month follow-up, and a reinforcement phone call and newsletters. Diet was assessed by the Dietary Risk Assessment (DRA), a validated food frequency questionnaire, at baseline, 3-, and 12-month follow-up; blood lipids and weight were assessed at baseline, 3-, 6-, and 12-month follow-up.

RESULTS

Participants were largely female (71%), older (mean age 55), and white (80%). At 3-month follow-up, the average reduction (indicating dietary improvement) in total Dietary Risk Assessment score was 3.7 units greater in the SI group (95% confidence interval [CI] 1.9 to 5.5, P = 0.0006), while both groups experienced a similar reduction in blood cholesterol, 14.1 mg/dL (0.37 mmol/L) for SI and 14.5 mg/dL (0.38 mmol/L) for minimal intervention group (difference -0.4 mg/dL [-0.010 mmol/L], 95% CI -12.5 to 11.7 [-0.32 to 0.30], P = 0.9). At 12-month follow-up, the reduction in total Dietary Risk Assessment score was 2.1 units greater in the SI group (95% CI 0.8 to 3.5, P = 0.005), while the reduction in blood cholesterol was similar in both groups, 18.4 mg/dL (0.48 mmol/L) for SI and 15.6 mg/dL (0.40 mmol/L) for minimal intervention group (difference 2.8 mg/dL [0.07 mmol/L], 95% CI -7.5 to 13.1 [-0.19 to 0.34], P = 0.6). During follow-up, weight loss was greater in the SI group; the difference between groups was statistically significant at 3 (1.9 lb [0.86 kg], 95% CI 0.3 to 3.4 [0.14 to 1.55], P = 0.022) and 6 months (2.1 lb [0.95 kg], 95% CI 0.1 to 4.1 [0.04 to 1.86], P = 0.04). At 12 months, the difference was not significant (1.6 lb [0.73 kg], 95% CI -0.05 to 3.7 [-0.02 to 1.68], P = 0.13).

CONCLUSIONS

Improvement in self-reported dietary intake was significantly greater in the SI group, while reduction in blood cholesterol was similar in both groups.

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  • Authors+Show Affiliations

    ,

    Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, 27599, USA. Alice_Ammerman@unc.edu

    , , , ,

    Source

    Preventive medicine 36:3 2003 Mar pg 340-51

    MeSH

    Adult
    Aged
    Blood Chemical Analysis
    Cholesterol, LDL
    Coronary Disease
    Counseling
    Dietary Fats
    Female
    Follow-Up Studies
    Humans
    Hypercholesterolemia
    Male
    Middle Aged
    North Carolina
    Nurse-Patient Relations
    Nutrition Assessment
    Patient Compliance
    Preventive Medicine
    Probability
    Public Health Nursing
    Reference Values
    Risk Assessment
    Rural Population
    Sampling Studies
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12634025

    Citation

    Ammerman, Alice S., et al. "A Randomized Controlled Trial of a Public Health Nurse Directed Treatment Program for Rural Patients With High Blood Cholesterol." Preventive Medicine, vol. 36, no. 3, 2003, pp. 340-51.
    Ammerman AS, Keyserling TC, Atwood JR, et al. A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterol. Prev Med. 2003;36(3):340-51.
    Ammerman, A. S., Keyserling, T. C., Atwood, J. R., Hosking, J. D., Zayed, H., & Krasny, C. (2003). A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterol. Preventive Medicine, 36(3), pp. 340-51.
    Ammerman AS, et al. A Randomized Controlled Trial of a Public Health Nurse Directed Treatment Program for Rural Patients With High Blood Cholesterol. Prev Med. 2003;36(3):340-51. PubMed PMID: 12634025.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterol. AU - Ammerman,Alice S, AU - Keyserling,Thomas C, AU - Atwood,Jan R, AU - Hosking,James D, AU - Zayed,Hany, AU - Krasny,Cristina, PY - 2003/3/14/pubmed PY - 2003/7/24/medline PY - 2003/3/14/entrez SP - 340 EP - 51 JF - Preventive medicine JO - Prev Med VL - 36 IS - 3 N2 - BACKGROUND: Many rural residents do not have access to high-quality nutrition counseling for high blood cholesterol. The objective of this study was to assess the effectiveness of an intervention program designed to facilitate dietary counseling for hypercholesterolemia by rural public health nurses. METHODS: Eight health departments (216 participants) were randomized to give the special intervention (SI) and nine (252 participants) to give the minimal intervention (MI). The SI consisted of three individual diet counseling sessions given by a public health nurse, using a structured dietary intervention (Food for Heart Program), referral to a nutritionist if lipid goals were not achieved at 3-month follow-up, and a reinforcement phone call and newsletters. Diet was assessed by the Dietary Risk Assessment (DRA), a validated food frequency questionnaire, at baseline, 3-, and 12-month follow-up; blood lipids and weight were assessed at baseline, 3-, 6-, and 12-month follow-up. RESULTS: Participants were largely female (71%), older (mean age 55), and white (80%). At 3-month follow-up, the average reduction (indicating dietary improvement) in total Dietary Risk Assessment score was 3.7 units greater in the SI group (95% confidence interval [CI] 1.9 to 5.5, P = 0.0006), while both groups experienced a similar reduction in blood cholesterol, 14.1 mg/dL (0.37 mmol/L) for SI and 14.5 mg/dL (0.38 mmol/L) for minimal intervention group (difference -0.4 mg/dL [-0.010 mmol/L], 95% CI -12.5 to 11.7 [-0.32 to 0.30], P = 0.9). At 12-month follow-up, the reduction in total Dietary Risk Assessment score was 2.1 units greater in the SI group (95% CI 0.8 to 3.5, P = 0.005), while the reduction in blood cholesterol was similar in both groups, 18.4 mg/dL (0.48 mmol/L) for SI and 15.6 mg/dL (0.40 mmol/L) for minimal intervention group (difference 2.8 mg/dL [0.07 mmol/L], 95% CI -7.5 to 13.1 [-0.19 to 0.34], P = 0.6). During follow-up, weight loss was greater in the SI group; the difference between groups was statistically significant at 3 (1.9 lb [0.86 kg], 95% CI 0.3 to 3.4 [0.14 to 1.55], P = 0.022) and 6 months (2.1 lb [0.95 kg], 95% CI 0.1 to 4.1 [0.04 to 1.86], P = 0.04). At 12 months, the difference was not significant (1.6 lb [0.73 kg], 95% CI -0.05 to 3.7 [-0.02 to 1.68], P = 0.13). CONCLUSIONS: Improvement in self-reported dietary intake was significantly greater in the SI group, while reduction in blood cholesterol was similar in both groups. SN - 0091-7435 UR - https://www.unboundmedicine.com/medline/citation/12634025/A_randomized_controlled_trial_of_a_public_health_nurse_directed_treatment_program_for_rural_patients_with_high_blood_cholesterol_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091743502000427 DB - PRIME DP - Unbound Medicine ER -