Improving lifestyle and risk perception through patient involvement in nurse-led cardiovascular risk management: a cluster-randomized controlled trial in primary care.
Koelewijn-van Loon M.S., van der Weijden T., Ronda G. et al. Preventive Medicine: 2010, 50, p. 35–44.

General practice patients in the Netherlands at risk of cardiovascular disease did not further reduce their risks (including drinking and smoking) in response to brief advice from the practice nurse intended to be delivered in accordance with motivational interviewing principles.

Summary:
Most patients at risk of cardiovascular diseases could benefit from various non-pharmacological risk-reduction options such as giving up smoking, exercising more, eating more healthily, and cutting their alcohol intake. However, it is not clear if programmes intended to foster these lifestyle changes are effective in the primary prevention of cardiovascular diseases. A systematic review of trials found no significant effects, though a recent trial showed that a nurse-coordinated programme achieved healthier lifestyle changes among patients at high risk.

The IMPALA study used a new intervention to reduce cardiovascular risk, in which general practice nurses play a central role. Key elements are risk assessment, risk communication, use of a patient decision support tool, and adapted motivational interviewing. Risk communication and the patient decision support tool inform patients about their risk of cardiovascular disease and options for risk reduction, and are also used to correct inappropriate risk perceptions. Motivational interviewing is used to help patients articulate their views and personal values regarding cardiovascular risk reduction and to build motivation for lifestyle change. In this study the intervention was delivered by practice nurses trained over two days and occupied two 20-minute face-to-face consultations (intended to give patients time to reflect on the information received in the first consultation) plus a further 10-minute telephone or face-to-face consultation to initiate the follow-up.

An earlier study found no impact a year after intervention but it was thought there might have been some shorter-term impacts, a possibility tested by the featured study. The study randomly allocated 25 general practices to the IMPALA intervention or to a control group whose nurses were trained for just two hours in risk assessment and apart from this merely applied usual care. One practice had to leave the study leaving 13 allocated to the intervention and 11 to the control group. Altogether they recruited 615 adult patients to the study who were eligible for cardiovascular risk assessment due to their blood pressure, cholesterol level, smoking, diabetes, family history or obesity. All but 67 were followed up 12 weeks later. They averaged about 57 years of age and 45% were men.