Patient cardiovascular risk self-management: results from a randomized trial of motivational interviewing delivered by practice nurses

Abstract

Background To enhance cardiovascular risk management and patients’ self-management, a tailored programme to improve cardiovascular risk management was tested in a randomized trial. The presented study concerned secondary analysis. Objectives To explore the correlations of practice nurses’ counselling skills at baseline on chronic illness care (measured with Patient Assessment of Chronic Illness Care questionnaire) and patients’ self-management (assessed with Patient Activation Measure) at follow-up and to examine the effect of the tailored implementation programme on chronic illness care and patients’ self-management. Methods A two-arm cluster randomized trial was conducted in 34 general practices in the Netherlands. Counselling skills of practice nurses at baseline were abstracted from audio-taped consultations, which were assessed by Motivational Interviewing Treatment Integrity. Data of 2184 patients with established cardiovascular disease or at high cardiovascular risk were gathered at inclusion and at 6 months follow-up by a composite questionnaire. Multilevel regression analysis was applied, controlling for patient characteristics. Results Counselling skills of practice nurses were not associated with chronic illness care and patients’ self-management scores. At follow-up, patients in the intervention group experienced less chronic illness care and were less activated in disease management than patients in the control group. The most important predictors were patients’ age, gender and education level. Conclusions The logic model underlying the implementation programme needs to be reconsidered, because patient perceptions were neither influenced by nurses’ counselling skills nor by other components of the implementation programme.

General practice nurses’ communication strategies for lifestyle risk reduction: A content analysis

“…Despite these MI interventions, there is variability in how communication about behaviour change is enacted in primary care (Noordman et al., 2012). Research examining GPNs’ use of MI has focused on their experiences, self‐perceived use, training, or quantitative analysis of the technique (Huntink, Koetsenruijter, Wensing, & Lieshout, 2019; Östlund, Wadensten, Häggström, & Kristofferzon, 2014; Östlund, Kristofferzon, Häggström, & Wadensten, 2016; Östlund, Wadensten, Kristofferzon, & Häggström, 2015). This study aimed to address a gap in the research through qualitative examination of how GPNs support lifestyle risk reduction with patients during chronic disease consultations using MI techniques.…”

Effectiveness of letters to patients with or without Cochrane blogshots on 10-year cardiovascular risk change among women in menopausal transition: 6-month three-arm randomized controlled trial

“…In the study by Laurant et al, experiences of chronic illness care in patients with established CVD or at high CVD risk did not change after the implementation of a tailored program aiming at nurses’ counseling skills [ 33 ]. On the other hand, a Cochrane systematic review by Huntink et al suggested that appropriately trained nurses can provide care of the same quality as primary care doctors and achieve similar health outcomes for patients [ 34 ]. While patient health outcomes were similar for nurses and doctors, patient satisfaction was higher with nurse-led care because nurses tended to provide longer consultations, give more information to patients, and recall patients more frequently than doctors.…”