Effectiveness of a Nurse-Based Intervention in a Community Practice on Patients' Dietary Fat Intake and Total Serum Cholesterol Level

Objective: To evaluate the effect of a nurse-based intervention for patients with high total cholesterol (TC) levels in a community practice. Design: Clinical trial without a control followed by a nonrandomized control trial. Setting: Suburban primary care practice. Patients: White patients with TC higher than 6.21 mmol/L (240 mg/dL). In the initial trial, 82 patients with a mean TC level of 6.80 mmol/L (263 mg/dL). Fifty-three preponderantly female patients in the nonrandomized control trial with a mean TC level of 6.83 mmol/L (264 mg/dL). Intervention: Counseling by office nurses using the Eating Pattern Assessment Tool and handouts with brand-specific food advice. In the initial study, patients attended up to 5 nurse counseling visits. In a follow-up study, intervention patients attending 2 or more counseling sessions were matched with other patients in the practice. Main Outcome Measures: Eating Pattern Assessment Tool scores in the initial study and TC levels in both trials. Results: Mean Eating Pattern Assessment Tool scores at baseline in both studies demonstrated that intervention patients were already following a diet consistent with the National Cholesterol Education Program Step I Diet. In the initial study, mean TC levels of the patients declined 2% (P<.05) and mean Eating Pattern Assessment Tool score improved from 23.4 to 20.4 (P<.001). In the follow-up study, the mean TC level of all patients improved significantly (P=.002). However, the improvement of the intervention patients was no better than that of the comparison patients. Conclusion: The nurse counseling intervention was not effective in patients already following a Step I Diet.