Abstract
LEARNING OUTCOME: To track changes in serum lipids of hyperlipidemic outpatients enrolled in a multi-class dietary/lifestyle intervention program in order to evaluate and improve the nutrition services provided.As the Department of Defense moves into managed care with capitated budgets, the selection of providers and services is increasingly based on outcomes. A number of studies have shown that medical nutrition therapy improves outcomes in hyperlipidemic patients. However, no studies specific to our population have been conducted. Of 807 hyperlipidemic patients referred to the clinic from July 1, 1992-June 30, 1993, only those patients with initial and follow-up lipid profiles were retrospectively assessed for changes in serum lipids associated with an intensive dietary/lifestyle intervention program. The initial mean total cholesterol, LDL, HDL, and triglycerides of the 172 patients, ages 30–81, were 254, 169, 48, and 190 mg/dL, respectively. In addition to a 1/2 hour individual appointment, each patient was offered 20 classes which could be completed in four months. A 95% patient satisfaction rate and an average attendance of six classes suggests compliance is increased with intensive program offerings. The mean total cholesterol for all patients decreased 8% by 1–3 months and 11% by > 18–24 months post-counseling. Patients receiving antihyperlipidemic agents (n=69) and those not receiving antihyperlipidemic agents (n=103) had similar changes in serum lipids. The t test showed no significant differences between the two groups in all lipoprotein changes at 1–3 months; however, patients receiving antihyperlipidemic agents had significantly greater changes (P<0.1) in triglycerides at > 18–24 months than patients receiving counseling alone. The results were used to recommend a treatment of hyperiipidemia protocol in a managed care environment that will likely decrease drug costs and increase nutrition clinic referrals.
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