Abstract
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.
Keywords
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References
- Summary of the second report of the National Cholesterol Education Program (NCEP).JAMA. 1993; 269: 3015-3023
- Prevalence of high blood cholesterol among US adults.JAMA. 1993; 269: 3009-3014
- Excess mortality in Harlem.N Engl J Med. 1990; 322: 173-177
- Dietary change for CVD prevention among black American families.Health Educ Rep. 1990; 5: 4
- Development and evaluation of a computer-based system for dietary management of hyperlipidemia.J Am Diet Assoc. 1997; 97: 146-150
- Electronic communication with patients evaluation of distance medicine technology.JAMA. 1997; 278: 152-159
- A model telephone information and support program for caregivers of Alzheimer’s disease.Gerontologist. 1990; 30: 399-404
- Assisted natural recovery from alcohol problems; effects of a self-help manual with and without supplementary telephone contact.Br J Addict. 1990; 85: 1177-1185
- Increasing influenza vaccination adherence through voice mail.Am J Geriat Soc. 1989; 37: 1147-1150
- A randomized trial of the effectiveness of computer-generated telephone messages in increasing immunization visits among preschool children.Arch Pediatr Adolesc Med. 1994; 148: 908-914
- Evaluation of telephoned computer-generated reminders to improve immunization coverage at inner-city clinics.Pub Health Rep. 1993; 1008: 426-430
- The virtual visit.J Am Med Informatics Assoc. 1997; 4: 413-425
- Maintenance of cholesterol reduction using automated telephone calls.Am J Prev Med. 1996; 12: 129-133
- Cholesterol-related knowledge, attitudes, and behaviors in a low-income, urban patient population.Am J Prev Med. 1993; 9: 282-289
- Social foundations of thought and action. Prentice Hall, Englewood Cliffs, NJ1986
- Change in public perspective on cholesterol and heart disease.JAMA. 1987; 258: 3527-3531
- Change in cholesterol awareness and action.Arch Intern Med. 1991; 151: 666-673
- The NWLRC Fat Intake Scale.J Am Diet Assoc. 1990; 90: 120
- Cholesterol-lowering diets.Arch Intern Med. 1995; 155: 17-26
- The Lipid Research Clinics Coronary Primary Prevention Trials results.JAMA. 1984; 251: 365-374
- Preventive efficacy of nutrition counseling.Arch Intern Med. 1996; 156: 1138
- Dietary reduction of serum cholesterol concentration.BMJ. 1993; 303: 953-957
- Can dietary interventions change diet and cardiovascular risk factors?.Am J Pub Health. 1997; 87: 1415-1422
- Use and outcomes of a cholesterol-lowering intervention for rural elderly subjects.Am J Prev Med. 1993; 9: 274-281
- A clinical trial of the American Heart Association Step One Diet for treatment of hypercholesterolemia.J Fam Pract. 1991; 33: 249-254
- A randomized controlled trial of a physician-directed treatment program for low-income patients with high blood cholesterol.Arch Fam Med. 1997; 6: 146-147
- Intraindividual variation of serum cholesterol, triglycerides and high-density lipoprotein cholesterol in normal humans.Atherosclerosis. 1982; 45: 259-266
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© 1998 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
