May 26, 2014
Web-based and live counseling programs effectively can reduce risk of heart disease for patients at high risk for the disease, and Web-based programs are particularly cost-effective, according to research from the University of North Carolina at Chapel Hill.
The work, published online May 26 in JAMA Internal Medicine, adds to a growing body of evidence suggesting that nontraditional approaches to health care are becoming ever more important in managing health and disease.
Co-authors of the study from the UNC Gillings School of Global Public Health include Carmen Samuel-Hodge, PhD, research assistant professor of nutrition; Kelly Evenson, PhD, research professor of epidemiology, Bryan Weiner, PhD, professor of health policy and management, Shrikant Bangdiwala, PhD, professor of biostatistics, and Alice Ammerman, DrPH, professor of nutrition and director of the UNC Center for Health Promotion and Disease Prevention (HPDP).
“Following a healthy lifestyle and taking prescribed medications can reduce the risk for heart disease,” said Thomas Keyserling, MD, MPH, lead author of the study. “However, most providers do not have the skills and resources to help their patients achieve these goals. Delivering programs in nontraditional and cost-effective ways gives providers more options to keep patients healthy.”
Keyserling and Stacey Sheridan, MD, MPH, led a team from the UNC Center for Health Promotion and Disease Prevention for the study. Both Keyserling and Sheridan are faculty members in the division of general medicine and clinical epidemiology in UNC’s School of Medicine. Sheridan also is an adjunct associate professor in the Gillings School’s Public Health Leadership Program.
“These programs offer doctors two great resources to serve their patients,” said Sheridan. “The Web program can be used to reach patients beyond the office and allows flexibility in the timing of counseling. The counselor intervention, on the other hand, offers the human interaction and can be personalized for those who need it.”
The researchers recruited project participants from five primary care practices in central North Carolina for a comparative effectiveness study. A total of 385 participants who did not have heart disease but who were at moderate to high risk for developing it were randomized into either the counselor-delivered or Web-based formats of the same intervention.
The primary outcome for the study was change in a calculated score, called the Framingham Risk Score, that predicts the chances of future heart disease events. This score was reduced substantially in both groups at four and 12 months follow-up. Also of note is that several risk factors improved, including blood pressure, blood cholesterol levels, self-reported dietary intake, physical activity and medication adherence.
In addition to examining health outcomes, the researchers compared the costs of each approach. The in-person counseling session cost $207 per patient, and the Web-based program cost $110 per person. Both interventions were cost-effective by commonly accepted standards, especially the Web-based format. Both intervention approaches were also very well received by participants, with 75 percent saying they would strongly recommend this program to others.
“We were pleased that the intervention appeared to be effective in both formats, highly acceptable to participants, and cost-effective,” said Keyserling. “This study provides support for the importance of combining lifestyle and medication interventions to reduce heart disease risk and for the cost-effectiveness of the Web-based format.”
The research was funded by the American Recovery and Reinvestment Act of 2009 through a grant from the Prevention Research Center (PRC) program at the U.S. Centers for Disease Control and Prevention (CDC) to the UNC Center for Health Promotion and Disease Prevention, which has been part of the PRC program since 1985.
Other School of Medicine researchers contributing to this project include Philip Sloane MD, Katrina Donahue MD, MPH, and Michael Pignone, MD, MPH. Pignone is also an adjunct professor of health behavior in the Gillings School.
Other major contributors from the UNC Center for Health Promotion and Disease Prevention include Maihan B. Vu, DrPH; Lindy Draeger, MPH; Ziya Gizlice, PhD; and Larry F. Johnston, MA. Key contributors to the cost-effectiveness analysis include Eric Finkelstein, PhD, MA, MHA, and Eliza Kruger, MHE, from the Duke-National University of Singapore Graduate Medical School, Singapore. Vu also is adjunct assistant professor of health behavior at the Gillings School.