Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial

Julia Bóveda-Fontán, Nieves Barragán-Brun, Manuel Campiñez-Navarro, Luís Ángel Pérula-de Torres, Josep M Bosch-Fontcuberta, Remedios Martín-Álvarez, Juan Carlos Arbonies-Ortiz, Jesús Manuel Novo-Rodríguez, Margarita Criado-Larumbe, Jose Angel Fernández-García, Enrique Martín-Rioboó, Collaborative Group Estudio Dislip-EM, Alexis Tena Domingo, Cristina Ortodó Parra, Gina Ballester Adell, Juantxo Mendive Arbeloa, Miriam Ruiz Sánchez, Silvia Membrilla Pastor, Laura Belmonte Calderón, Luís Martínez Pallí, Neus Fernández Danés, Sonia Cibrián Sánchez, Ana Roldán Villalobos, Antonio Pérez Fuentes, Felix Suárez González, Francisco Mora Moreno, Isabel de Andrés Cara, M Dolores Vargas Rubio, Manuel Rico Cabrera, María Pineda Alonso, Clara Soria López, Antonio León Dugo, Antonio López Hernández, Antonio Valero Martín, Cristina Aguado Taberné, Emilio García Criado, Francisca Pérez Fuentes, Francisco Caro Tejero, José Luis Montero Monterroso, M José Acosta García, Pilar Serrano Varo, Juan Manuel Parras Rejano, M Jesús Cobas Martínez, Silvia Díez Moreno, Susana Hernáiz Valero, Antonio Fernández Crespo, M Dolores Pazo Ferreiro, Rosana Izquierdo Fernández, Susana Aldecoa Landesa, Jose Antonio Prados Castillejo, Julia Bóveda-Fontán, Nieves Barragán-Brun, Manuel Campiñez-Navarro, Luís Ángel Pérula-de Torres, Josep M Bosch-Fontcuberta, Remedios Martín-Álvarez, Juan Carlos Arbonies-Ortiz, Jesús Manuel Novo-Rodríguez, Margarita Criado-Larumbe, Jose Angel Fernández-García, Enrique Martín-Rioboó, Collaborative Group Estudio Dislip-EM, Alexis Tena Domingo, Cristina Ortodó Parra, Gina Ballester Adell, Juantxo Mendive Arbeloa, Miriam Ruiz Sánchez, Silvia Membrilla Pastor, Laura Belmonte Calderón, Luís Martínez Pallí, Neus Fernández Danés, Sonia Cibrián Sánchez, Ana Roldán Villalobos, Antonio Pérez Fuentes, Felix Suárez González, Francisco Mora Moreno, Isabel de Andrés Cara, M Dolores Vargas Rubio, Manuel Rico Cabrera, María Pineda Alonso, Clara Soria López, Antonio León Dugo, Antonio López Hernández, Antonio Valero Martín, Cristina Aguado Taberné, Emilio García Criado, Francisca Pérez Fuentes, Francisco Caro Tejero, José Luis Montero Monterroso, M José Acosta García, Pilar Serrano Varo, Juan Manuel Parras Rejano, M Jesús Cobas Martínez, Silvia Díez Moreno, Susana Hernáiz Valero, Antonio Fernández Crespo, M Dolores Pazo Ferreiro, Rosana Izquierdo Fernández, Susana Aldecoa Landesa, Jose Antonio Prados Castillejo

Abstract

Background: It is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care.

Methods: A multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines.

Results: 107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference -MD- = -19.60; 95 % CI: -15.33 at -23.87 mg/dl; p < 0.001), LDL-cholesterol levels (MD = -13.78; 95 % CI: -9.77 at -17.79 mg/dl; p < 0.001) and triglycerides (MD = -19.14; CI 95 %: -11.29 at -26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95 % CI: 1.67-19.91).

Conclusion: A Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise.

Trial registration: the trial is registered in ClinicalTrials.gov ( NCT01282190 ; January 21, 2011).

Figures

Fig. 1
Fig. 1
Flowchart of participants according to the CONSORT Group recommendations
Fig. 2
Fig. 2
Evolution of mean total cholesterol levels throughout the study by group (mg/dl)
Fig. 3
Fig. 3
Evolution of mean LDL- cholesterol levels throughout the study by group (mg/dl)
Fig. 4
Fig. 4
Evolution of mean total triglyceride levels throughout the study by group (mg/dl)
Fig. 5
Fig. 5
Patients with lipid control in the final visit depending on the group

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