Dietary intervention for cholesterol reduction in public clinic patients
Dietary intervention for cholesterol reduction in public clinic patients
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DOI：
10.1016/s0749-3797(98)00038-5
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发表时间：
1998-08-01
影响因子：
5.5
通讯作者：
Simons-Morton, D
中科院分区：
文献类型：
--
作者：
Hyman, DJ;Ho, KSI;Simons-Morton, D
目的：测试饮食干预（包括互动邮件、电脑生成电话和课程）对高胆固醇血症低收入公共诊所患者的可行性和有效性。方法：临床患者血清胆固醇>200 mg/dl，由其初级保健医生推荐随机分为6个月的特殊干预（SI）或常规护理（UC）。干预包括邮寄、电脑电话和四节1小时的课程。在干预前后测定血清总胆固醇（TC），并监测参与情况。结果：212例患者中有165例（77.8%）同意参与。一项医疗记录审查显示，123人（74.5%）符合资格标准。符合条件的受试者平均年龄为56.7岁，80.0%为非洲裔美国人，74.8%为女性，33.6%为已婚，89.4%为高中及以下学历。受试者随机分组，80.5%（99人）完成随访胆固醇测量。鼓励SI受试者使用所有三个组成部分，84.6%（65人中有55人）积极参与至少一个组成部分。72%（65人中有47人）至少回复了一封邮件，使用按键式电话的人中有49.1%（57人中有28人）访问了计算机系统，43.1%（65人中有28人）参加了课程。SI组TC由273.2 mg/dl降至265.0 mg/dl (P = 0.05)， UC组TC由272.4 mg/dl降至267.6 mg/dl （P = 0.32）。与UC相比，SI的净减少量为3.4 mg/dl （P = 0.58）。结论：(1)低收入公立诊所患者会参与饮食干预；(2)计算机生成的交互式电话在该人群中是可行的；(3)实际强度的干预难以实现有临床意义的血清胆固醇降低。
Objectives: To test the feasibility and effectiveness of a diet intervention (consisting of interactive mailings, computer-generated phone calls, and classes) in hypercholesterolemic low-income public clinic patients.Methods: Clinic patients with serum cholesterol >200 mg/dl, referred by their primary care physician were randomized to a 6-month special intervention (SI) or usual care (UC). The intervention included mailings, computer phone calls, and four 1-hour classes. Serum total cholesterol (TC) was measured before and after intervention, and participation was monitored.Results: One hundred sixty-five of the 212 patients referred (77.8%) agreed to participate. A medical records review revealed 123 (74.5%) met eligibility criteria. Eligible subjects had a mean age of 56.7 years, 80.0% were African American, 74.8% were female, 33.6% were married, and 89.4% had a high school or lower education. Subjects were randomized with 80.5% (99) completing follow-up cholesterol measures. SI subjects were encouraged to use all three components, with 84.6% (55 of 65) actively participating in at least one component. Seventy-two percent (47 of 65) returned at: least one mailing, 49.1% (28 of 57) of those with touch-tone phones accessed the computer system, and 43.1% (28 of 65) attended classes. The TC in SI decreased from 273.2 mg/dl to 265.0 mg/dl (P = 0.05) and in UC 272.4 mg/dl to 267.6 mg/dl (P = 0.32). The net reduction in SI compared with UC was 3.4 mg/dl (P = 0.58).Conclusions: (1) Low-income public clinic patients will participate in diet interventions, (2) computer-generated interactive phone calls are feasible in this population, and (3) clinically meaningful decreases in serum cholesterol are difficult to achieve with interventions of practical intensity.