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Impact of Training Primary Care Physicians in Behavioral Counseling to Reduce Cardiovascular Disease Risk Factors in Quito, Ecuador
Author(s) -
Fornasini Marco,
Baldeon Manuel Eduardo,
Zevallos Juan Carlos,
Flores Nancy,
Rosal Milagros,
Merriam Philip,
Ockene Ira
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.975.9
Subject(s) - medicine , anthropometry , diabetes mellitus , incidence (geometry) , population , disease , physical therapy , primary care , blood pressure , family medicine , type 2 diabetes , randomized controlled trial , environmental health , physics , optics , endocrinology
Background Previous published literature has shown that cardiovascular risk factor management programs conducted during physician visits in developed countries result in a decrease in the risk for cardiovascular diseases. The purpose of this study was to determine the feasibility of a physician‐training program for diabetes and cardiovascular risk reduction in an at‐risk population in Ecuador, a developing country now facing a rapidly increasing incidence of diabetes and cardiovascular disease. Methods A randomized clinical trial was conducted in 6 primary care clinics in Quito, Ecuador. Participants included 15 primary care physicians (PCPs) and a sample of their adult patients at risk for type‐2 diabetes. A twelve‐step physician‐based and patient‐centered counseling training program aimed at decreasing cardiovascular risk was delivered to 8 PCPs. Seven additional PCPs who did not receive the training comprised the control group. The patient experience regarding counseling steps addressed by their physician was assessed by patient exit interviews (PEIs) which were administered immediately following the first post‐recruitment patient appointment. Anthropometrics, blood pressure, blood biochemistry parameters, and assessment of patient compliance with medication were conducted at baseline and after 6‐months follow‐up. Changes from baseline as well as differences between groups were estimated utilizing Chi‐square, ANOVA and paired t‐tests. Results A total of 197 patients were enrolled, 113 in the intervention care (IC) group and 84 in the usual care (UC) group; 99 patients (87.6%) in the IC group and 63 (75%) in the UC group completed the study between June 2014 and June 2016. Overall, participants from both study groups had similar socio‐demographic characteristics. The mean number of completed counseling steps, as measured by the PEI, were significantly higher in the IC group (8.9±1.6 vs. 6.6±2.3; p=0.001) and a significant reduction in glycated hemoglobin was seen in that group; p=0.023. Data also showed that within the IC group there were significant improvements in weight, Body Mass Index, total cholesterol, and LDL‐cholesterol. Conclusions Our findings show that training PCPs in patient‐centered counseling for cardiovascular risk factor reduction is successful. Implementation of this educational strategy in Ecuador and other countries undergoing an epidemiologic transition could reduce both diabetes and cardiovascular risk among high‐risk patients. Support or Funding Information International Atherosclerosis Society& Pfizer International