ABSTRACT
Objective:To investigate the efficacy of personalized family doctor contract services on risk factors of atherosclerotic cardiovascular disease (ASCVD) in high-risk population.Methods:Ten matched-community health centers of Shenzhen Luohu district were divided into intervention group and control group by cluster randomiztion. Subjects with high risks of ASCVD were screened out as intervention group from contracted residents who visited these centers and had complete data of the China-PAR model from August 2018 to April 2019. The control group received conventional general family doctor contract services. The individualized management were given to the intervention group after fully understanding patients′ ideas, concerns, and expectations (ICE). After 2-year intervention, score changes of ASCVD risk factors within and between groups were compared.Results:A total of 571 patients were enrolled, including 288 in the intervention group and 283 in the control group. After 2 years of intervention, 7 and 18 were lost to follow-up in two groups, respectively. Finally, 281 in the intervention group and 265 in the control group were included in the study. At baseline, there was no significant difference in ASCVD scores between the intervention group and the control group [(13.33±3.54) vs. (13.09±3.54) points; t=0.84, P=0.403], and the scores in both groups decreased significantly after the intervention [(10.89±4.01), (11.62±4.11) points], while the intervention group decreased more significantly (both P<0.05). Among the risk factors at baseline, HDL-C and diastolic blood pressure in the intervention group were lower than those in the control group, and there were no significant differences in other factors between the two groups. After the intervention, the levels of total cholesterol, systolic blood pressure and diastolic blood pressure in the two groups decreased significantly, and the number of people taking antihypertensive drugs increased significantly ( P<0.001 and P<0.05); HDL-C decreased in the control group ( P=0.023). After the intervention, compared to control group the intervention group had a higher proportion of patients taking antihypertensive drugs, with lower systolic and diastolic blood pressure ( P<0.05). After the intervention, the increase rate of HDL-C in the intervention group was more than that in the control group, and the decrease rate was less than that in the control group (χ 2=6.65, P=0.036). Conclusion:Family doctor contract services can reduce the risk factors of ASCVD, and personalized family doctor contract services can further improve the effects in the prevention and control of ASCVD. However, the effects might be insignificant and inconsistent for the ASCVD risk factors with deeper management requirements or no specific management measures, which highlights the complexity and diversity of ASCVD prevention and control, calling for multi-level and multi-faceted thinking and exploration.
ABSTRACT
Objective:To explore whether health and wellness coaching can promote healthy lifestyle among highrisk people with stroke.Methods:The highrisk people with stroke admitted to the hospital were randomly divided into a test group (49) and a control group (49) by excel random function method.The control group was given telephone health education once a week, a total of 12 times last 3 months; On this basis, the test group carried out from every week to every months,a total of 8 timeshealth and wellness coaching, measuring the health promotion lifestyle (HPLP-Ⅱ) scale scores of the two groups of subjects at baseline, at the end of the intervention, and 3 months after the end of the intervention.Results:There was no statistical difference in the general demographic data of the two groups of subjects. Repeated measures analysis of variance showed that three months after the intervention, the two groups of subjects had statistically significant differences in nutrition, health responsibilities, physical activity, self-actualization, and health promotion lifestyle scores between the groups, time, and interaction ( F values were 12.131-502.649, P<0.01). There were no statistical differences in interpersonal relationship and stress coping dimensions ( P>0.05). Simple effect analysis found that at the end of the intervention, the two groups of subjects had only statistical differences between the self-actualization dimension and the total score of health promotion lifestyle ( P<0.01). Three months after the end of the intervention, the total scores of nutrition, health responsibilities, sports, self-actualization and health-promoting lifestyles of the two groups of study subjects were significantly different ( P<0.01). Conclusions:Health and wellness coaching can promote healthy lifestyle among highrisk people with stroke.