DIETARY INTERVENTION FOR CHOLESTEROL REDUCTION IN PUBLIC CLINIC PATIENTS

Objectives: To test the feasibility and effectiveness of a diet interv ention (consisting of interactive mailings, computer-generated phone c alls, and classes) in hypercholesterolemic low-income public clinic pa tients. Methods: Clinic patients with serum cholesterol >200 mg/dl, re ferred by their primary care physician were randomized to a 6-month sp ecial intervention (SI) or usual care (UC). The intervention included mailings, computer phone calls, and four 1-hour classes. Serum total c holesterol (TC) was measured before and after intervention, and partic ipation was monitored. Results: One hundred sixty-five of the 212 pati ents referred (77.8%) agreed to participate. A medical records review revealed 123 (74.5%) met eligibility criteria. Eligible subjects had a mean age of 56.7 years, 80.0% were African American, 74.8% were femal e, 33.6% were married, and 89.4% had a high school or lower education. Subjects were randomized with 80.5% (99) completing follow-up cholest erol measures. SI subjects were encouraged to use all three components , with 84.6% (55 of 65) actively participating in at least one compone nt. Seventy-two percent (47 of 65) returned at: least one mailing, 49. 1% (28 of 57) of those with touch-tone phones accessed the computer sy stem, and 43.1% (28 of 65) attended classes. The TC in SI decreased fr om 273.2 mg/dl to 265.0 mg/dl (P = 0.05) and in UC 272.4 mg/dl to 267. 6 mg/dl (P = 0.32). The net reduction in SI compared with UC was 3.4 m g/dl (P = 0.58). Conclusions: (1) Low-income public clinic patients wi ll participate in diet interventions, (2) computer-generated interacti ve phone calls are feasible in this population, and (3) clinically mea ningful decreases in serum cholesterol are difficult to achieve with i nterventions of practical intensity.