PHYSICIANS AND NURSES CAN BE EFFECTIVE EDUCATORS IN CORONARY RISK REDUCTION

OBJECTIVES: 1) To compare the impact of a brief physician or nurse education session with the impact of education provided by dietitians on patient knowledge regarding coronary risk factors, dietary recommendations, and compliance, and 2) to determine the value of additional formal dietary counseling on knowledge, dietary fat, and serum lipids. DESIGN: Primary care physicians and their office nurses were compared with inpatient dietitians by evaluating patient performance on a standardized test and three-day dietary food choices. Neither the educators nor the patients were aware of the study. Supplemental information was provided by a study dietitian and patients were reevaluated six weeks later. SETTING: Preventive cardiology program in a university-affiliated teaching hospital. PARTICIPANTS: Fifty consecutive patients referred to a preventive cardiology program who had received dietary and cardiac risk factor information within the preceding six weeks by a physician and office nurse (27) or an inpatient dietitian (23) were enrolled. Forty-five patients completed the study objectives. INTERVENTIONS: The patients completed a three-day food record, fasting lipids, and a test of knowledge of coronary risk factors and dietary concepts. The correct answers were discussed and a standard American Heart Association phase I diet was recommended. Six weeks later dietary food records, fasting lipids, and the test were repeated. MEASUREMENTS AND MAIN RESULTS: By participant recall, the dietitians (group II) spent an average of 30.6 +/- 25 minutes, compared with 8.2 +/- 14.4 minutes by the physicians and nurses (group I) (p < 0.05). Group II patients had a higher total knowledge score, but they were no better in risk factors, weight control, or calculated dietary fat or cholesterol. There was no correlation between time spent and percentage of calories from fat or total test score. Six weeks after the program instruction the mean cholesterol level for all the participants was reduced, and group II had a lower fat intake than did group I, which was associated with significantly lower serum cholesterol, not present at entry. CONCLUSION: Primary care physicians and their office nurses, using less time than do dietitians, can be effective educators in providing patient education for coronary risk reduction and dietary fat intake. A second formal dietary consultation appears beneficial in improving compliance and lipid control.