A brief behavioral feedback intervention in hospital outpatients with a high cardiovascular risk

doi:10.1016/j.pec.2004.11.011

Patient Education and Counseling

Volume 60, Issue 1, January 2006, Pages 32-40

https://doi.org/10.1016/j.pec.2004.11.011 Get rights and content

Abstract

Objective

Examining the prevalence of risk behavior and motivation to change among hospital outpatients with a high cardiovascular risk, and the implementation and results of a brief behavioral feedback intervention by internists.

Methods

One hundred and sixty-one patients completed a lifestyle questionnaire and were given personalized feedback on the results by their internists. The delivery of the feedback was monitored. In an ad hoc non randomized comparison after four months, 68 patients who received an intervention were compared with 40 who did not receive it.

Results

Ninety-six percent of the patients demonstrated at least one risk behavior and 73% were not contemplating change. The intervention was correctly given to 62%. The patients who received the intervention reported more lifestyle changes and altered their motivation to change more often.

Discussion

Given the prevalence of risk behavior lifestyle interventions are worthwhile. Internists delivered the intervention to most patients. Small effects of the intervention were found, but the non-experimental nature of the study should be taken into account.

Conclusion

Implementation of a behavioral feedback intervention seems to be feasible and can lead to worthwhile lifestyle changes for patients at risk for cardiovascular disease.

Practice implications

Training and education can improve the intervention. Also a nurse practitioner can perform part of it.

Introduction

Smoking, physical inactivity, poor dietary habits and excessive use of alcohol can cause or negatively influence several chronic diseases and should be regarded as risk behaviors [1]. In patients with a high cardiovascular risk, modification of an unhealthy lifestyle is of major importance [2], [3], [4], [5], [6], [7]. Medical specialists are in the unique position to promote patients’ health, since they frequently encounter patients at crucial moments, when responsiveness to preventive intervention is high [8]. Medical specialists often feel inadequate to act accordingly, however. A considerable workload; lack of time, knowledge or motivation; doubts about the effectiveness; and inadequate skills are the most important barriers [8], [9], [10].

Brief interventions by general practitioners are effective in reducing risk behaviors among patients [11], [12]. Therefore, it is worthwhile to study the effectiveness of brief interventions when applied by internists. This study assessed the need, implementation, and results of a brief, individually tailored behavioral feedback intervention for patients at cardiovascular risk in an outpatient clinic for general internal medicine. The three questions examined were: (1) What is the prevalence of risk behaviors and readiness to change among patients with a high cardiovascular risk profile? (2) Is it possible to implement a brief behavioral feedback intervention conducted by the internist? (3) What are the results of this feedback intervention?

Section snippets

Study design

To assess the prevalence of risk behaviors and patients’ readiness to change, a cohort of patients with a high cardiovascular risk profile completed a lifestyle questionnaire [13]. To evaluate the implementation, the delivery of the brief feedback intervention, to be done in the first and second visits to the internist, was monitored with a questionnaire for both patients and internists and medical file observations during a 15-month period since the initial visit. To evaluate the outcome,

Patient recruitment

During the study period, 356 patients with a high cardiovascular risk profile visited the clinic (Fig. 1). In total, 142 (39.9%) patients were excluded for the following reasons: age (63%), unable to complete the questionnaire (8%), refusal to complete the questionnaire (3.5%), comorbidity (3.5%), or according to exclusion criteria not further indicated by the internists (22%). For 23 (6.4%) patients, the internists did not fill in the screening forms for unclear reasons. Of the remaining 191

Discussion

Ninety-six percent of the patients with a high cardiovascular risk profile who visited an outpatient clinic for general internal medicine exhibited cardiovascular risk behavior. Ninety percent had at least one unhealthy eating habit, half should increase the amount of physical activity, a quarter smoked, and 15% drank too much alcohol. However, three quarter of the patients was not contemplating change. The relatively large number of patients with unhealthy eating habits in the precontemplation

Conflict of interest

None.

Acknowledgements

Funding: The research (PROJECTNR: 31000017) is funded by ZonMw ‘Netherlands Organisation for Health Research and Development’. We thank Kerianne Watt for her comments on the text of the last version.

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View full text

A brief behavioral feedback intervention in hospital outpatients with a high cardiovascular risk

Abstract

Objective

Methods

Results

Discussion

Conclusion

Practice implications

Introduction

Section snippets

Study design

Patient recruitment

Discussion

Conflict of interest

Acknowledgements

Prev Med

Am J Clin Nutr

Int J Cardiol

Lancet

Gen Hosp Psychiat

Leefstijlgewoonten en het verloop van chronische ziekten [Lifestyle habits and the cause of chronic diseases]

Tijdschr Soc Gezondheidsz

The risk of alcohol: an update ten years on [dissertation]

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

Diabetologia

Effects of alcohol consumption on mortality in patients with Type 2 diabetes mellitus

Diabetologia

Optimal diets for prevention of coronary heart disease

JAMA—J Am Med Assoc

Missed opportunities for prevention in general internal medicine

Can Med Assoc J

Internists’ practices in health promotion and disease prevention: a survey

Ann Intern Med

Opinions on alcohol-related issues among professionals in primary, occupational, and specialized health care

Alcohol Alcoholism

Effect of general practitioners’ advice against smoking

Brit Med J

Leefstijlvragenlijst [Lifestyle questionnaire]