Multifactor cardiovascular disease risk reduction in medically underserved, high-risk patients

被引:42
作者
Haskell, William L. [1 ]
Berra, Kathleen
Arias, Elizabeth
Christopherson, Dianne
Clark, Annette
George, Jan
Hyde, Shauna
Klieman, Linda
Myll, Jeff
机构
[1] Stanford Univ, Stanford Prevent Res Ctr, Sch Med, Stanford, CA 94305 USA
[2] Univ Washington, Sch Med, Seattle, WA 98195 USA
关键词
D O I
10.1016/j.amjcard.2006.06.049
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Few data exist on the effectiveness of cardiovascular disease (CVD) risk-reduction programs in patients with limited access to health care. The objective of this project was to evaluate a disease management approach to multifactor CVD risk reduction in patients with limited or no health insurance and low family income. Patients (n = 148) were recruited from not-for-profit or free clinics and hospitals and randomized to usual care or usual care plus team case management. Mean age was 59.3 years, 57% were women, 50% had less than,a high school education, 57% were Hispanic, and 64% had no health insurance. All had >= 1 increased risk factor for CVD, and 24.5 % had documented coronary artery disease. Follow-up measurements were obtained at 6 and 12 months. Primary outcomes were low-density lipoprotein cholesterol and systolic blood pressure. The disease management program was supervised by a physician, delivered by nurses and dietitians, and included comprehensive lifestyle changes and medications. Data were collected on 91% of patients at 12 months. Disease management produced clinically important decreases in selected risk factors compared with usual care, including systolic blood pressure (p < 0.01) and low-density lipoprotein cholesterol, (p < 0.03). More patients with disease management than those with usual care moved from "high" and "very-high" risk to lower risk categories for selected risk factors. In conclusion, the disease management program had excellent retention and lower CVD risk factors and demonstrated the potential of such approaches for decreasing long-term disease burden in selected medically underserved populations. (c) 2006 Elsevier Inc. All rights reserved.
引用
收藏
页码:1472 / 1479
页数:8
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