A. McKnight

Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk

Abstract Objective: To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities. Design: Randomised controlled trial of personal health education given every four months. Setting: 18 general practices in the greater Belfast area. Subjects: 688 patients aged less than 75 years and known to have had angina for at least six months; 342 randomised to receive education and 346 to no education. Main outcome measures: Restriction of everyday activities, dietary habit, smoking habit, frequency of physical exercise; blood pressure, body mass index, and serum total cholesterol concentration at entry to trial and after two years. Results: 317 in the intervention group and 300 in the control group completed the trial. At the two year review more of the intervention group (140, 44%) reported taking daily physical exercise than the control group (70, 24%). The intervention group also reported eating a healthier diet than the control group and less restriction by angina in any everyday activity. No significant differences were found between the groups in smoking habit, systolic or diastolic blood pressure, cholesterol concentration, or body mass index. Conclusion: Despite having no significant effect on objective cardiovascular risk factors, personal health education of patients with angina seems to increase exercise and improve dietary habits and is effective in lessening the restriction of everyday activities.

Cost effectiveness of personal health education in primary care for people with angina in the greater Belfast area of Northern Ireland.

STUDY OBJECTIVE: To investigate the cost effectiveness of personal health education for angina patients being treated in general practice. DESIGN: A randomised controlled trial in which people were randomised to intervention and control groups. All were assessed at the start and end of the study, with details recorded of disease status, coronary heart disease risk factors, and self assessed quality of life. A note was taken of their current use of drugs and over the course of the study their use of all health services. Those in the intervention group had three visits per year from a health visitor, whose brief was discuss ways of living more easily with their disease and in which risks of further events might be reduced. PATIENTS: Altogether 688 patents in the Greater Belfast area aged less than 75 years and known to have angina for at least six months. MAIN RESULTS: Significant improvements in survival and self assessed quality of life were found between the study and control groups. The intervention was associated with a reduction in drug usage and there was no significant difference between the intervention and control groups in terms of their use of other health services. CONCLUSION: Given the improvement in survival and self assessed quality of life and no significant differences in costs to the health service between the two groups, the intervention was deemed to be cost effective.

Measurement of Markers of Tobacco Smoking in Patients with Coronary Heart Disease

591 patients with a history of coronary heart disease had one or more biochemical markers of tobacco smoking measured. 26% were self reported smokers and a further 4% were apparent ‘smoking deceivers’. The urinary nicotine metabolite concentration is an excellent marker for tobacco smoking; breath CO would be a suitable alternative for busy clinics. Half the patients were subjected to regular advice on risk factor management but there was no evidence that this contributed effectively to smoking cessation. Overall smoking cessation rate was poor.

A comparison of three measures of perceived distress: results from a study of angina patients in general practice in Northern Ireland.

OBJECTIVE: To establish the effect of health education on the level of distress felt by patients with angina and to compare the results obtained using different measures. DESIGN: Randomised controlled trial of personal health education given every four months. SETTING: Eighteen general practices in the greater Belfast area. SUBJECTS: These comprised 688 patients aged less than 75 years and known to have had angina for at least six months: 342 were randomised to receive education and 346 no education. MAIN OUTCOME MEASURES: These were the Nottingham health profile (NHP), functional limitation profile (FLP), and a simple categorical scale (SCS). RESULTS: The intervention group showed a statistically significant improvement in health relative to the control group in terms of physical mobility and social isolation using the NHP. In terms of overall wellbeing, both the NHP and SCS results showed the intervention group had experienced statistically significant improvements in health relative to the control group. Results obtained using the NHP, FLP, and SCS were found to be correlated regardless of whether weighted or unweighted scores were used. CONCLUSION: The intervention produced a significant improvement in health status. Results from different survey instruments were correlated using both weighted and unweighted scores. An SCS was capable of detecting the improvement in health status.

A general practice trial of health education advice and HRT to prevent bone loss

Seventy-four women were randomised to a two-year prospective study comparing advice and written information on diet and exercise with similar advice and information supplemented by hormone replacement therapy. Both groups were given a menopausal questionnaire and had bone mineral density measured at entry and after two years on treatment. Patients taking HRT were significantly less likely to complain of anxiety, vaginal dryness and hot flushes but singificantly more likely to complain of weight gain. There was a 20 per cent increase in bone mineral density within the HRT group after two years treatment and althouth clinically significant this just failed to reach statistical significance.

Secondary prevention of coronary heart disease in primary care is cost effective

EDITOR,—Neither of two recent studies that estimated the cost of health checks in primary care was able to show cost effectiveness.1 2 It has been suggested that larger trials with longer follow up are required to assess fully the long term effectiveness and overall cost effectiveness of population cardiovascular screening. The value of …

A survey of perimenopausal women's knowledge and attitude to risk factors and therapy for osteoporosis

AbstractOsteoporosis is an important health problem for older women in that approximately 50 per cent of females sustain a fracture of the hip/wrist/vertebrae by the age of 70.1 The morbidity associated with osteoporosis related problems costs the NHS £700 million per annum.1 Hormone replacement therapy has been available for nearly 40 years, is an effective treatment in preventing osteoporosis and yet only 9 per cent of eligible women take this treatment.2 Studies to date have concentrated on womens attitude and knowledge to HRT.2,3 Given that our objective was to extend preventative care services to our perimenopausal patients we felt that a wider survey of womens knowledge and attitude to risk factors and treatments for osteoporosis would enable us to identify the educational issues raised and allow us to target information. We were particuarly interested to determine the effect of social class on attitude and behaviour.

Influence of sociodemographic factors and hormone replacement on climacteric symptoms

Objectives: To identify the prevalence and severity of recognised climacteric symptoms in middle-aged women and to examine their relationship with menopausal status, sociodemographic factors and the use of hormone-replacement therapy.Methods: 358 women between 48 and 52 years inclusive, registered with general practitioners in an innercity Belfast Health Centre, were invited to participate in a cross-sectional study in the primary care setting. The main outcome measures were menopausal status, social class, marital status, employment status, HRT status and climacteric symptoms.Results: Psychological symptoms were as commonly reported as vasomotor symptoms. Only 8% of women had never experienced any symptoms, 88% experienced one or more symptoms which they found tolerable and 54% had one or more disturbing symptoms. Peri- and postmenopausal women reported significantly more symptoms than premenopausal women. Women in the lower social classes, married/cohabiting women and women not in employment had a signi...