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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3076 — The Effectiveness of Personalized Coronary Heart Disease and Stroke Risk Communication

Powers BJ (Center for Health Services Research in Primary Care, Durham COE), Danus S (Center for Health Services Research in Primary Care, Durham COE), Grubber JM (Center for Health Services Research in Primary Care, Durham COE), Olsen MK (Center for Health Services Research in Primary Care, Durham COE), Oddone EZ (Center for Health Services Research in Primary Care, Durham COE), Bosworth HB (Center for Health Services Research in Primary Care, Durham COE)

Objectives:
Current guidelines recommend global risk assessment to guide vascular risk factor management; however, most provider-patient communication focuses on individual risk factors in isolation. We sought to evaluate the impact of personalized coronary heart disease (CHD) and stroke risk communication on patients’ knowledge, beliefs, and health behavior.

Methods:
We conducted a randomized controlled trial testing personalized risk communication based on Framingham stroke and CHD risk scores compared to standard risk factor education. Personalized risk communication included bar charts of estimated 10 year risk for each patient along with age-matched average and optimized risk estimates. Eighty-nine high risk veterans with blood pressure > 140/90mmHg were recruited from primary care clinics and followed for 3-months. Outcomes included: risk perception and worry; risk factor knowledge; risk reduction preferences and decision conflict; medication adherence; health behaviors; and blood pressure.

Results:
Participants had very low understanding of numeric information, high perceived risk for stroke or heart attack, and a high proportion of medication non-adherence at baseline. Patients’ ability to identify vascular risk factors increased with personalized risk communication (mean 1.8 additional risk factors correctly identified, 95% CI, 1.3-2.2) and standard risk factor education (mean 1.6 additional risk factors correctly identified, 95% CI, 1.1-2.1) immediately following the intervention, but the improvement was not sustained at 3 months when correct identification of risk factors returned to baseline values. Patients in the personalized group had less decision conflict than standard risk factor education group over intended risk reduction strategies (5.9 vs. 10.1; p = 0.003). There was no appreciable impact of either communication strategy on medication adherence, exercise, smoking cessation, or blood pressure.

Implications:
Personalized risk communication was preferred by patients and had a small impact on risk reduction preferences and decision conflict; there was no impact on patient beliefs or behavior compared to standard risk factor education.

Impacts:
Personalized CHD and stroke risk communication may play an important role in shaping patient risk perceptions, but alone, is unlikely to influence long term risk reduction behavior.


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