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A cluster randomised controlled trial of vascular risk factor management in general practice

Mark F Harris, Mahnaz Fanaian, Upali W Jayasinghe, Megan E Passey, Suzanne H McKenzie, Gawaine Powell Davies, David M Lyle, Rachel A Laws, Heike Schütze and Qing Wan
Med J Aust 2012; 197 (7): 387-393. || doi: 10.5694/mja12.10313

Summary

Objective: To evaluate the impact of a lifestyle intervention in Australian general practice to reduce the risk of vascular disease.

Design, setting and participants: Stratified cluster randomised controlled trial among 30 general practices in New South Wales from July 2008 to January 2010. Patients aged 40–64 years were invited to participate. The subgroup who were 40–55 years of age were included only if they had either hypertension or dyslipidaemia.

Intervention: A general practice-based health-check with brief lifestyle counselling and referral of high-risk patients to a program consisting of one to two individual visits with an exercise physiologist or dietitian, and six group sessions.

Main outcome measures: Outcomes at baseline, 6 and 12 months included the behavioural and physiological risk factors for vascular disease — self-reported diet and physical activity, and measured weight, body mass index, waist circumference, blood lipid and blood sugar levels, and blood pressure.

Results: Of the 3128 patients who were invited, 958 patients (30.6%) responded and 814 were eligible to participate. Of these, 699 commenced the study, and 655 remained in the study at 12 months. Physical activity levels increased to a greater extent in the intervention group than the control group at 6 and 12 months (P = 0.005). There were no other changes in behavioural or physiological outcomes or in estimated absolute risk of cardiovascular disease at 12 months. Of the 384 enrolled in the intervention group, 117 patients (30.5%) attended the minimum number of group program sessions and lost more weight (mean weight loss, 1.06 kg) than those who did not attend the minimum number of sessions (mean weight gain, 0.73 kg).

Conclusion: While patients who received counselling by their general practitioner increased self-reported physical activity, only those who attended the group sessions sustained an improvement in weight. However, more research is needed to determine whether group programs offer significant benefits over individual counselling in general practice.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12607000423415.

  • Mark F Harris1
  • Mahnaz Fanaian2
  • Upali W Jayasinghe1
  • Megan E Passey3
  • Suzanne H McKenzie4
  • Gawaine Powell Davies1
  • David M Lyle5
  • Rachel A Laws6
  • Heike Schütze1
  • Qing Wan1

  • 1 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.
  • 2 Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW.
  • 3 University Centre for Rural Health North Coast, University of Sydney, Sydney, NSW.
  • 4 James Cook University, Townsville, QLD.
  • 5 Broken Hill University Department of Rural Health, University of Sydney, Sydney, NSW.
  • 6 Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW.

Correspondence: m.f.harris@unsw.edu.au

Acknowledgements: 

This research was funded by an Australian National Health and Medical Research Council project grant. We acknowledge the involvement of the other members of the HIPS research team and the involvement of participating DGPs, practices and patients.

Competing interests:

No relevant disclosures.

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