Abstract
BackgroundTo evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm).MethodsThis was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36.ResultsBoth study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were −30.09% and −27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended).ConclusionPatients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn.Trial registrationNational Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370
Highlights
To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia
Disease management services delivered by primary care physicians assisted by nurse educators (PCP-NE) demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; the improvements were not maintained when the services were withdrawn
Studies have shown that chronic disease management are associated with marked improvements in many clinical outcomes associated with cardiovascular diseases [6,7,8,9]; many developing countries have yet to integrate CDM into their primary healthcare systems due to limited resources and systems orientated towards acute symptomatic care [4]
Summary
To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. Low-and middle-income countries are the biggest contributors to the increase in cardiovascular disease burden [2] It varies among countries, the factors contributing to the escalating prevalence of chronic diseases are an ageing population, tobacco use, unhealthy diet practices and physical inactivity, urbanisation and global marketing [3], where half of these risk factors are modifiable through behaviour modification. Primary healthcare plays a pivotal role in gearing patients towards positive behaviour management [4] This can be achieved through the use of a chronic disease management (CDM) model, which emphasises the integration of several elements including multidisciplinary care delivery, patient education and provider decision support, selfmanagement and patient empowerment support, clinical information technology, social support and quality incentives within the primary health care system [5]. There is paucity of literature that addresses the sustainability of chronic disease management programmes in developing countries, in terms of its efficacy and cost
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
