Volume 198 - Issue 8
A cluster randomised controlled trial of vascular risk factor management in general practice
Author: Mark F Harris
Med J Aust 2013; 198 (8): 414-414. || doi: 10.5694/mja12.11844
Published online: 20 May 2013
Published online: 20 May 2013
In reply: The Health Improvement and Prevention Study (HIPS) and the Greater Green Triangle study are not comparable. HIPS was a cluster randomised controlled trial of a pragmatic intervention that was delivered by general practitioners (through Divisions of General Practice) and was analysed on an intention-to-treat (ITT) basis.1 The Greater Green Triangle study was a pre-post study of patients recruited in GP waiting rooms who ...
In reply: The Health Improvement and Prevention Study (HIPS) and the Greater Green Triangle study are not comparable. HIPS was a cluster randomised controlled trial of a pragmatic intervention that was delivered by general practitioners (through Divisions of General Practice) and was analysed on an intention-to-treat (ITT) basis.1 The Greater Green Triangle study was a pre–post study of patients recruited in GP waiting rooms who completed a program delivered by study staff (ie, it was not analysed on an ITT basis).2
Dietary measures of fruit and vegetable consumption were chosen for HIPS because use of weighed food records (which are required to measure polyunsaturated : saturated fat ratio and salt intake) would have reduced participation. Participants in the intervention group self-monitored diet and physical activity, and they received individual feedback from allied health professionals and further feedback in group sessions.
The Counterweight program, on which HIPS was based, produced 5% weight loss3 and did so cost-effectively.4 It has been adopted in Scotland and England. Weight loss of this magnitude reduces risk factors for cardiovascular disease and diabetes.5 The program uses goal setting, self-monitoring, relapse prevention, cognitive restructuring and stimulus control.6
Stages of change were used to identify patients appropriate for referral to the HIPS program. HIPS was effective in reducing weight among program attendees but not on ITT analysis — a result that reflects real-world barriers to engaging patents in lifestyle-modification programs.
Competing interests
No relevant disclosures.
References
- Harris MF, Fanaian M, Jayasinghe UW, et al. A cluster randomised controlled trial of vascular risk factor management in general practice. Med J Aust 2012; 197: 387-393. 0_CHDBHCDH
- Laatikainen T, Philpot B, Hankonen N, et al. Predicting changes in lifestyle and clinical outcomes in preventing diabetes: the Greater Green Triangle Diabetes Prevention Project. Prev Med 2012; 54: 157-161. 0_i1142869
- Counterweight Project Team. Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 2008; 58: 548-554. 0_pgfId-2767375
- Counterweight Project Team. Long-term cost-effectiveness of weight management in primary care. Int J Clin Pract 2010; 64: 775-783. 0_CBBDIGCI
- Counterweight Project Team. The Counterweight programme: prevalence of CVD risk factors by body mass index and the impact of 10% weight change. Obes Res Clin Pract 2008; 2: 15-27. 0_CBBHCGID
- Laws R; Counterweight Project Team. A new evidence-based approach to weight management in primary care: the Counterweight Programme. J Hum Nutr Diet 2004; 17: 191-208. 0_CBBCDHIA