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