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Live counseling, Web-based interventions reduced CHD risk
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A combined lifestyle and medication intervention offered in a counselor-delivered or Web-based format reduced CHD risk through 1 year of follow-up.
“Given increasing evidence that supports the effectiveness of Web-based interventions, we developed a combined [lifestyle and medication] intervention to reduce CHD risk and tested it in two formats: counselor-delivered and Web-based. While the counselor intervention provides human interaction and offers the potential for a higher degree of tailoring, the Web intervention has greater reach, offers flexibility to patients in the timing and delivery of the intervention, and minimizes clinical staff demands and costs,” Thomas C. Keyserling, MD, MPH, of the division of general medicine and clinical epidemiology at the University of North Carolina School of Medicine, and colleagues wrote.
The researchers studied 385 patients aged 35 to 79 years from five diverse family medicine practices in North Carolina. All patients were at risk for CHD (10-year Framingham risk score ≥10%) and had no history of CVD. The patients were randomly assigned a counselor-delivered (n=192) or Web-based format (n=193); both included four intensive sessions and three maintenance sessions. After randomization, both formats used a Web-based decision aid to show the potential reductions in CHD risk associated with lifestyle and medication risk-reduction strategies, according to the study abstract.
Ninety-one percent of randomly assigned participants completed 4 months of follow-up and 87% completed 12 months of follow-up.
According to the results, the primary outcome of sustained reduction in Framingham risk score at 4 months was reduced by –2.3% in the counselor-based group and –1.5% in the Web-based group. At 12 months, Framingham risk score was reduced by –1.9% in the counselor-based group and –1.7% in the Web-based group. The adjusted difference between the groups was –1% at 4 months (P=.03) and –0.6% at 12 months (P=.3).
“This risk reduction was achieved by improvements in lifestyle or medication use, or both, and mediated through improvements in blood pressure, blood lipid levels, cigarette smoking and aspirin use,” Keyserling and colleagues wrote.
The researchers also evaluated acceptability and cost-effectiveness of both formats. At 12 months, the cost from the payer perspective was $207 per person for the counselor-based format and $110 per person for the Web-based format.
“These findings reinforce increasing evidence suggesting that Web-based interventions can have an important role in clinical practice,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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