Nurse/health worker-led intervention improves CVD risk profile
MedWire News: An intervention delivered by a nurse practitioner/community health worker (NP/CHW) team improves the risk profile of cardiovascular disease (CVD) patients more than an enhanced usual care (EUC) program does, researchers say.
This finding supports the potential for nurse-led patient-centered medical homes to improve the quality of care in high-risk underserved populations, report Jerilyn Allen (Johns Hopkins University School of Nursing, Baltimore, Maryland, USA) and co-workers in the journal Circulation.
The analysis included 525 patients with documented CVD, Type 2 diabetes, hypercholesterolemia, or hypertension, and low-density lipoprotein (LDL) cholesterol levels of 100 mg/dL or more, blood pressure (BP) of more than 140/90 mmHg, or HbA1c level of 7% or more. The patients were randomly assigned to treatment by a NP/CHW team (n=261) or with EUC (control group; n=264).
Patients in the EUC group received usual care from their primary provider, which was enhanced by feedback regarding CVD risk factors given to the patient and their provider.
Those in the NP/CHW group received EUC plus management by the NP/CHW team, which comprised aggressive pharmacological management, tailored educational and behavioral counseling for lifestyle modification, identification of barriers to adherence and control, phone follow-ups between visits, and pre-appointment reminders.
At 12 months, patients who received treatment with NP/CHW had a significantly greater overall improvement from baseline in total cholesterol and LDL cholesterol than those in the EUC group, at absolute between-group differences of 19.7 mg/dL and 15.9 mg/dL, respectively.
Similarly, the NP/CHW group had bigger reductions in triglycerides, systolic BP, diastolic BP, and HbA1c, with between-group differences of 16.3 mg/dL, 6.2 mmHg, 3.1 mmHg, and 0.5%, respectively.
In addition, at 12 months, a significantly higher proportion of patients in the NP/CHW group than the EUC group reached guideline goals for, or showed clinically significant improvements in, LDL cholesterol (75 vs 58%, p<0.001), systolic BP (82 vs 74%, p=0.018), and HbA1c (60 vs 47%, p=0.016).
Patients' assessments of their chronic illness care (according to the Patient Assessment of Chronic Illness Care Survey) also improved significantly from baseline to 12 months in the NP/CHW group, at a difference of -1.4 points compared with -0.2 points in the EUC group (p<0.001).
Commenting on future implications for their research, the authors conclude: "Further analyses will evaluate the cost-effectiveness of NP/CHW model… to determine if this translates into improved morbidity and mortality from CVD."
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By Piriya Mahendra