The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial
Open Access
- 10 October 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Family Practice
- Vol. 13 (1), 97
- https://doi.org/10.1186/1471-2296-13-97
Abstract
To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm). This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were −30.09% and −27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended). Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn. National Medical Research Registration (NMRR) Number: NMRR-08-287-1442 Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370Keywords
This publication has 22 references indexed in Scilit:
- Community Outreach and Cardiovascular Health (COACH) TrialCirculation: Cardiovascular Quality and Outcomes, 2011
- Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER DatabaseJournal of Lipid Research, 2010
- Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health careThe Lancet, 2008
- Chronic Diseases in Developing CountriesAnnals of the New York Academy of Sciences, 2008
- High density lipoprotein cholesterol: an evolving target of therapy in the management of cardiovascular diseaseVascular Health and Risk Management, 2008
- Improving the quality of health care for chronic conditionsQuality and Safety in Health Care, 2004
- Coaching patients On Achieving Cardiovascular Health (COACH)Archives of Internal Medicine, 2003
- A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterolPreventive Medicine, 2003
- Nurse case management of hypercholesterolemia in patients with coronary heart disease: Results of a randomized clinical trialAmerican Heart Journal, 2002
- A low-fat diet decreases high density lipoprotein (HDL) cholesterol levels by decreasing HDL apolipoprotein transport rates.JCI Insight, 1990