Impact of training primary care physicians in behavioral counseling to reduce cardiovascular disease risk factors in Ecuador

• Main Authors: Manuel E. Baldeón, Marco Fornasini, Nancy Flores, Philip A. Merriam, Milagros Rosal, Juan C. Zevallos, Ira Ocken
• Format: Article
• Language: English
• Published: Pan American Health Organization 2018-09-01
• Series: Revista Panamericana de Salud Pública
• Subjects: Cardiovascular diseases; health human resource training; diabetes mellitus, type 2; cholesterol, HDL; cholesterol, LDL; blood pressure; Ecuador
• Online Access: http://iris.paho.org/xmlui/handle/123456789/49468
• ISSN: 1020-4989; 1680-5348

Objective. To assess the feasibility of implementing a physician-based, patient-centered counseling intervention model in Ecuador to improve the ability of primary care physicians (PCPs) to reduce cardiovascular disease (CVD) risk factors among patients. Methods. This was a randomized clinical trial conducted in primary care clinics in Quito in 2014 – 2016. Participants included 15 PCPs and their adult patients at high risk of developing type-2 diabetes. A physician-based and patient-centered counseling program was delivered to eight PCPs. Seven PCPs who did not receive the training comprised the control group. The patient experience was assessed by a patient exit interview (PEI). Assessment of the patient's anthropometrics, blood pressure, and blood biochemistry parameters were conducted. Changes within and between groups were estimated utilizing chi-square, ANOVA, paired t-tests, and coefficient with intervention. Results. A total of 197 patients participated, 113 in the intervention care group (ICG) and 84 in the usual care group (UCG); 99 patients (87.6%) in the ICG and 63 (75%) in the UCG completed the study. Counseling steps, measured by the PEI, were significantly higher in the ICG (8.9±1.6 versus 6.6±2.3; P = 0.001). Comparison of the estimated difference between the ICG and the UCG showed greater decreases in HbA1c and total cholesterol in the ICG. Within the ICG, there were significant improvements in weight, BMI, HbA1C, total cholesterol, and LDL-cholesterol. Conclusions. Training PCPs in a patient-centered behavioral intervention for CVD risk factor reduction is feasible and efficacious for reducing CVD risk factors in Ecuador. Developed and developing countries alike could benefit from such an intervention.