The Understanding and Interpretation of Innovative Technology-Enabled Multidimensional Physical Activity Feedback in Patients at Risk of Future Chronic Disease

Background To understand better the success of self-management interventions and to enable tailoring of such interventions at specific subgroups of patients, the nurse-led Activate intervention is developed targeting one component of self-management (physical activity) in a heterogeneous subgroup (patients at risk of cardiovascular disease) in Dutch primary care. Aim The aim of this study was to evaluate the effectiveness of the Activate intervention and identifying which patient-related characteristics modify the effect. Methods A two-armed cluster-randomised controlled trial was conducted comparing the intervention with care as usual. The intervention consisted of four nurse-led behaviour change consultations within a 3-month period. Data were collected at baseline, 3 months and 6 months. Primary outcome was the daily amount of moderate to vigorous physical activity at 6 months. Secondary outcomes included sedentary behaviour, self-efficacy for physical activity, patient activation for self-management and health status. Prespecified effect modifiers were age, body mass index, level of education, social support, depression, patient provider relationship and baseline physical activity. Results Thirty-one general practices ( n = 195 patients) were included (intervention group n = 93; control group n = 102). No significant between-group difference was found for physical activity (mean difference 2.49 minutes; 95% confidence interval -2.1; 7.1; P = 0.28) and secondary outcomes. Patients with low perceived social support ( P = 0.01) and patients with a low baseline activity level ( P = 0.02) benefitted more from the intervention. Conclusion The Activate intervention did not improve patients’ physical activity and secondary outcomes in primary care patients at risk of cardiovascular disease. To understand the results, the intervention fidelity and active components for effective self-management require further investigation. Trial registration: ClinicalTrials.gov NCT02725203.

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INCREASING PHYSICAL ACTIVITY AMONG PATIENTS AT RISK FOR HEART DISEASE

Medicine & Science in Sports & Exercise ◽

10.1097/00005768-200305001-00408 ◽

2003 ◽

Vol 35 (Supplement 1) ◽

pp. S75

Author(s):

J Norstrom ◽

S E. Sullivan ◽

W Conroy ◽

A Tarnowski ◽

N Liwienski ◽

...

Keyword(s):

Physical Activity ◽

At Risk ◽

Heart Disease ◽

Patients At Risk

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Strategies for identifying pulmonary sarcoidosis patients at risk for severe or chronic disease

Expert Review of Respiratory Medicine ◽

10.1080/17476348.2017.1281745 ◽

2017 ◽

Vol 11 (2) ◽

pp. 111-118 ◽

Cited By ~ 14

Author(s):

Marc A. Judson

Keyword(s):

At Risk ◽

Chronic Disease ◽

Pulmonary Sarcoidosis ◽

Patients At Risk

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Chronic Disease Registers in Primary Healthcare

Handbook of Research on Informatics in Healthcare and Biomedicine ◽

10.4018/978-1-59140-982-3.ch005 ◽

2011 ◽

pp. 35-43

Author(s):

M. F. Harris ◽

D. Penn ◽

J. Taggart ◽

Andrew Geogious ◽

J. Burns ◽

...

Keyword(s):

At Risk ◽

Chronic Disease ◽

Primary Healthcare ◽

Clinical Care ◽

Evidence Based ◽

Critical Data ◽

Structured Care ◽

Patients At Risk ◽

Evidence Based Guidelines ◽

Provision Of Care

Systematic care of patients with chronic diseases needs to be underpinned by information systems such as disease registers. Their primary function is to facilitate structured care of patients attending services—supporting identification of patients at risk, structured preventive care and provision of care according to guidelines, and supporting recall of patients for planned visits. In Australia general practitioners using division-based diabetes registers are more likely to provide patient care that adhered to evidence-based guidelines. Critical data issues include privacy, ownership, compatability, and capture as part of normal clinical care and quality.

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Abstract P077: Missed Opportunities for Behavioral Counseling by Primary Care Providers

Circulation ◽

10.1161/circ.133.suppl_1.p077 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

John D Omura ◽

Susan A Carlson ◽

Prabasaj Paul ◽

Kathleen B Watson ◽

Fleetwood Loustalot ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

At Risk ◽

Primary Care Providers ◽

Care Providers ◽

Behavioral Counseling ◽

The Metabolic Syndrome ◽

Patients At Risk ◽

Risk Patients ◽

Counseling Practices

Background: In 2014, the US Preventive Services Task Force recommended adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Hypothesis: We hypothesized that primary care providers (PCPs) who discussed physical activity with most of their at risk patients would have a higher prevalence of offering select components than PCPs who discussed physical activity less frequently. Methods: DocStyles 2015, a Web-based panel survey of 1251 PCPs (response rate=76.8%), assessed physical activity counseling practices with patients at risk for CVD (overweight or obese and with hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome). Results: Overall, 55.9% (SE=1.4) of PCPs discussed physical activity with most of their patients at risk for CVD. Among respondents who discussed physical activity with any at risk patients (N=1244), the prevalence of components offered when they counseled ranged from 92.6% encouraging increased physical activity to 15.8% referring to intensive behavioral counseling (Table). PCPs who discussed physical activity with most at risk patients had a higher prevalence of offering all counseling components assessed than PCPs who discussed physical activity less frequently, except for referring to intensive behavioral counseling where no difference was found. Of all PCPs, 8.4% both discussed physical activity with most of their at risk patients and referred them to intensive behavioral counseling. Conclusion: Just over half of PCPs surveyed discussed physical activity with most patients at risk for CVD. These PCPs more frequently offered select components when they counseled with the exception of referral to intensive behavioral counseling. Both the low levels of counseling and referral to intensive behavioral counseling present important opportunities for improving counseling practices.

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Brugada

American Journal of Critical Care ◽

10.4037/ajcc2001.10.5.360 ◽

2001 ◽

Vol 10 (5) ◽

pp. 360-364 ◽

Cited By ~ 9

Author(s):

LG Futterman ◽

L Lemberg

Keyword(s):

Physical Activity ◽

At Risk ◽

Brugada Syndrome ◽

Clinical Importance ◽

Vagal Activity ◽

St Segment Elevation ◽

Minor Criterion ◽

St Segment ◽

Patients At Risk ◽

Genetically Determined

The Brugada syndrome was first described in 1992. Palpitations and/or syncope are usually experienced during rest and increased vagal activity. [table: see text] However, in 15% of patients with Brugada syndrome, symptoms occur during physical activity. The syndrome is further characterized by a pattern of RBBB and ST-segment elevation in V1 to V2/V3 (see Table). One major and one minor criterion from the Table can serve to establish a diagnosis of Brugada syndrome. The patient presented in this report described symptoms only during physical activity. EPS confirmed the diagnosis of the Brugada syndrome, and an ICD was implanted. The clinical importance of the Brugada syndrome is that it calls attention to patients at risk for SCD. The syndrome is genetically determined and caused by mutations in the cardiac ion channels. Signal averaging that reveals late potentials can help identify persons who may be at high risk for SCD and who would thus be candidates for EPS, which can identify those at risk of SCD. The ICD is the only therapy known to help prevent SCD in patients with Brugada syndrome.

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Abstract P379: Features to Increase Primary Care Provider Referrals to Intensive Behavioral Counseling for Cardiovascular Disease Prevention

Circulation ◽

10.1161/circ.141.suppl_1.p379 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

John D Omura ◽

Kathleen B Watson ◽

Fleetwood V Loustalot ◽

Janet E Fulton ◽

Susan A Carlson

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Primary Care ◽

At Risk ◽

Task Force ◽

Primary Care Providers ◽

Care Providers ◽

Behavioral Counseling ◽

Patients At Risk ◽

Risk Patients

Background: The US Preventive Services Task Force recommends adults with certain cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling to promote a healthful diet and physical activity for CVD prevention. However, only 1 in 12 primary care providers (PCPs) currently follow this recommendation. This study assessed system and programmatic features PCPs reported would increase their likelihood of referring patients at risk for CVD to intensive behavioral counseling and whether this varied by the percentage of at-risk patients with whom they discuss physical activity. Methods: DocStyles 2018, a web-based panel survey of PCPs, assessed the percentage of at-risk patients with whom PCPs discuss physical activity and the degree to which select features would increase their likelihood of referring to intensive behavioral counseling. Results: Overall, 60.8% of PCPs discussed physical activity with most of their at-risk patients; 21.8% did so with many and 17.4% with few or some. The proportion of PCPs identifying features as increasing their likelihood of referring to intensive behavioral counseling by a great extent ranged from 24.1% for an automated referral in electronic health records, 35.3% for patient progress reports, 41.5% for the program being accredited or evidence-based, to 67.2% for the program having no cost to the patient (Table). These proportions increased for each feature as the percentage of at-risk patients with whom they discuss physical activity increased. Conclusion: PCPs identified programmatic features (i.e. being accredited and of no cost) as having the greatest influence on their likelihood of referring patients at risk for CVD to intensive behavioral counseling, although this varied by the percentage of at-risk patients with whom they discuss physical activity. Findings suggest that the effectiveness of strategies to improve behavioral counseling referrals by PCPs may depend on their current physical activity counseling practices.

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Changes in Health Behaviours in Adults At-Risk of Chronic Disease: Primary Outcomes From The My Health for Life Program

10.21203/rs.3.rs-895190/v1 ◽

2021 ◽

Author(s):

Charrlotte Seib ◽

Stephanie Moriarty ◽

Nicole McDonald ◽

Debra Anderson ◽

Joy Parkinson

Keyword(s):

Physical Activity ◽

Risk Factors ◽

At Risk ◽

Chronic Disease ◽

Waist Circumference ◽

Healthy Lifestyle ◽

Disease Risk ◽

Vegetable Consumption ◽

Health Behaviours ◽

Fruit And Vegetable

Abstract Background Chronic disease is the leading cause of premature death globally, and many of these deaths are preventable by modifying some key behavioural and metabolic risk factors. This secondary data analysis examines changes in health behaviours among men and women at risk of diabetes or cardiovascular disease (CVD) who participated in a 6-month lifestyle intervention called the My health for life program. Methods My health for life is a government-funded multi-component program designed to reduce chronic disease risk factors amongst at-risk adults. The intervention comprises six sessions over a 6-month period, delivered by a trained facilitator or telephone health coach. The analysis presented in this paper stems from 9,372 participants who participated in the program between July 2017 and December 2019. Primary outcomes included fruit and vegetable intake, consumption of sugar-sweetened drinks and take-away, alcohol and tobacco smoking, physical activity, body mass index (BMI), and waist circumference (WC). Variables were summed to form a single Healthy Lifestyle Index (HLI) ranging from 0 to 18, with higher scores denoting healthier behaviours. Longitudinal associations between lifestyle indices, assessed using Gaussian Generalized Estimating Equations (GEE) models with an identity link and robust standard errors. Results Improvements in HLI scores were noted between baseline (Md = 10.0; IQR = 8.3, 11.7] and 26-weeks (Md = 11.7; IQR = 10.0, 13.2] which corresponded with increases in fruit and vegetable consumption and decreases in takeaway frequency, and weight indices (p < .01 for all) but not risky alcohol intake. Modelling showed higher average HLI among those aged 45 or older (β = 0.97, 95% CI = 0.81, 1.13, p < .01) with vocational educational qualifications (certificate/diploma: β = 0.47, 95% CI = 0.19, 0.76, p < .01; bachelor/post-graduate degree β = 1.05, 95% CI = 0.76, 1.34, p < .01) while being male, Aboriginal or Torres Strait Islander background, or not currently working conferred lower average HLI scores (p < .01 for all). Conclusions While participants showed improvements in many healthy lifestyle indices including BMI, waist circumference, physical activity, and dietary indicators, changes in alcohol consumption were less amenable to the program. There is a need for additional research to understand the multi-level barriers and facilitators of behaviour change in this context to tailor the intervention for more-difficult-to-treat groups.

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