Abstract
BackgroundThe non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner.Methods/DesignAn open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines.DiscussionMotivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity.Trials RegistrationClinicalTrials.gov (NCT01282190).
Highlights
The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity
Simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health
-As a self-control and reinforcing mechanism, after the interview, professionals will fill in an autochecklist by using the EVEM questionnaire. This project represents an attempt to advance on an aspect of health care that is considered key in Western health systems today due to its high magnitude: testing the most effective preventive approaches in the fight against Heart Disease in primary care
Summary
The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Many efforts have been devoted to explain changes in or adherence to specific health behaviors Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. From the perspective of primary care (PC) the role of general practitioners -GPs- is essential in the prevention of dyslipidemia, both in terms of detection and of the therapeutic approach employed In this sense, we know that healthy lifestyle recommendations are based on more robust scientific evidence (grade A and B recommendations) than the pharmacological treatment itself, when prescribed (grade D recommendation) [4]. The impact of such interventions was from low to moderate, and most of the measures are recommended for their effectiveness in reducing morbidity and mortality, rather than for the fact that there is strong evidence that PC interventions help change health behaviors [6]
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