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Ira S Ockene - One of the best experts on this subject based on the ideXlab platform.
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comparing food intake using the dietary risk assessment with multiple 24 hour dietary recalls and the 7 day dietary recall
Journal of The American Dietetic Association, 1999Co-Authors: Barbara C Olendzki, Thomas G Hurley, James R Hebert, Sarah Ellis, Philip A Merriam, Rose S Luippold, Linda Rider, Ira S OckeneAbstract:The Dietary Risk Assessment (DRA) is a brief dietary assessment tool used to identify dietary behaviors associated with cardiovascular disease. Intended for use by physicians and other nondietitians, the DRA identifies healthful and problematic dietary behaviors and alerts the physician to patients who require further Nutrition Counseling. To determine the relative validity of this tool, we compared it to the 7-Day Dietary Recall (an instrument developed to assess intake of dietary fat) and to the average of 7 telephone-administered 24-hour dietary recalls. Forty-two free-living subjects were recruited into the study. The 7-Day Dietary Recall and DRA were administered to each subject twice, at the beginning and the end of the study period, and the 24-hour recalls were conducted during the intervening time period. Correlation coefficients were computed to compare the food scores derived from the 3 assessment methods. Correlations between the DRA and 7-Day Dietary Recall data were moderate (r = .47, on average, for postmeasures); correlations between the DRA and 24-hour recalls were lower. The ability of the DRA to assess dietary fat consumption and ease of administration make it a clinically useful screening instrument for the physician when Counseling patients about dietary fat reduction.
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effect of physician delivered Nutrition Counseling training and an office support program on saturated fat intake weight and serum lipid measurements in a hyperlipidemic population worcester area trial for Counseling in hyperlipidemia watch
JAMA Internal Medicine, 1999Co-Authors: Ira S Ockene, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M Saperia, Edward J Stanek, Robert J Nicolosi, Thomas G HurleyAbstract:Objective: To evaluate the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood lowdensity lipoprotein cholesterol levels in patients with hyperlipidemia. Participants and Methods: Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician Nutrition Counseling training; and (3) physician Nutrition Counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3hour training program on the use of brief patientcentered interactive Counseling and the use of an officesupport program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels. Results: Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P,.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial Counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group. Conclusion: Brief supported physician Nutrition Counseling can produce beneficial changes in diet, weight, and blood lipids. Arch Intern Med. 1999;159:725-731
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effect of training and a structured office practice on physician delivered Nutrition Counseling the worcester area trial for Counseling in hyperlipidemia watch
American Journal of Preventive Medicine, 1996Co-Authors: Ira S Ockene, Thomas G Hurley, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M SaperiaAbstract:We examined the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with a structured office practice environment for Nutrition management, on physicians' Counseling practices. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization (the Fallon Clinic) were enrolled into a randomized controlled trial. Physicians were randomized by site into three conditions: (1) usual care, (2) physician Nutrition Counseling training, and (3) physician Nutrition Counseling training plus a structured office practice environment for Nutrition management (prompts and the provision of lipid results and Counseling algorithms). A randomly selected 325 patients were given a 10-item patient exit interview (PEI) assessing whether the physician provided advice; assessed past changes, barriers, and resources; negotiated specific plans and goals; provided patient materials; referred the patient to a dietitian; and developed plans for follow-up. Condition 3 physicians demonstrated significantly greater implementation of the Nutrition Counseling sequence than did physicians in either of the other two conditions (P < .0001). Referrals to Nutrition services were markedly reduced in condition 2, despite PEI scores no different than those in condition 1. Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training. Primary care internists, when provided with both training in Counseling techniques and a supportive office environment, will carry out patient Counseling appropriately. Training alone, however, is not sufficient and may be counterproductive. Medical Subject Headings (MeSH): hypercholesterolemia, diet therapy, coronary disease, health behavior, primary health care, medical education, managed care programs.
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physician training for patient centered Nutrition Counseling in a lipid intervention trial
Preventive Medicine, 1995Co-Authors: Judith K Ockene, James R Hebert, Philip A Merriam, Rose S Luippold, Ira S Ockene, Gordon M Saperia, Mark E Quirk, Sarah EllisAbstract:Abstract Background. We examined the effect of a 3-hr training program on physicians′ lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered Counseling to enable patients with elevated lipids to change their dietary patterns. Method. The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training, using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported Nutrition intervention practices, and Counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. Results. After completion of the program the physicians′ use of dietary Counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased x pre = 5.4, x post = 9.2; t = 9.9; P ≤ 0.001). In this regard, there were increases in the use of 7 of the 14 specific Counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale ( x pre = 3.2, x post = 4.0; t = 4.25; P x pre = 3.3, x post = 3.9; t = 3.16; P x pre = 2.7, x post = 4.0; t = 5.29; P x pre = 3.5, x = 4.0; t = 2.63; P
Gordon M Saperia - One of the best experts on this subject based on the ideXlab platform.
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effect of physician delivered Nutrition Counseling training and an office support program on saturated fat intake weight and serum lipid measurements in a hyperlipidemic population worcester area trial for Counseling in hyperlipidemia watch
JAMA Internal Medicine, 1999Co-Authors: Ira S Ockene, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M Saperia, Edward J Stanek, Robert J Nicolosi, Thomas G HurleyAbstract:Objective: To evaluate the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood lowdensity lipoprotein cholesterol levels in patients with hyperlipidemia. Participants and Methods: Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician Nutrition Counseling training; and (3) physician Nutrition Counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3hour training program on the use of brief patientcentered interactive Counseling and the use of an officesupport program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels. Results: Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P,.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial Counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group. Conclusion: Brief supported physician Nutrition Counseling can produce beneficial changes in diet, weight, and blood lipids. Arch Intern Med. 1999;159:725-731
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effect of training and a structured office practice on physician delivered Nutrition Counseling the worcester area trial for Counseling in hyperlipidemia watch
American Journal of Preventive Medicine, 1996Co-Authors: Ira S Ockene, Thomas G Hurley, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M SaperiaAbstract:We examined the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with a structured office practice environment for Nutrition management, on physicians' Counseling practices. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization (the Fallon Clinic) were enrolled into a randomized controlled trial. Physicians were randomized by site into three conditions: (1) usual care, (2) physician Nutrition Counseling training, and (3) physician Nutrition Counseling training plus a structured office practice environment for Nutrition management (prompts and the provision of lipid results and Counseling algorithms). A randomly selected 325 patients were given a 10-item patient exit interview (PEI) assessing whether the physician provided advice; assessed past changes, barriers, and resources; negotiated specific plans and goals; provided patient materials; referred the patient to a dietitian; and developed plans for follow-up. Condition 3 physicians demonstrated significantly greater implementation of the Nutrition Counseling sequence than did physicians in either of the other two conditions (P < .0001). Referrals to Nutrition services were markedly reduced in condition 2, despite PEI scores no different than those in condition 1. Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training. Primary care internists, when provided with both training in Counseling techniques and a supportive office environment, will carry out patient Counseling appropriately. Training alone, however, is not sufficient and may be counterproductive. Medical Subject Headings (MeSH): hypercholesterolemia, diet therapy, coronary disease, health behavior, primary health care, medical education, managed care programs.
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physician training for patient centered Nutrition Counseling in a lipid intervention trial
Preventive Medicine, 1995Co-Authors: Judith K Ockene, James R Hebert, Philip A Merriam, Rose S Luippold, Ira S Ockene, Gordon M Saperia, Mark E Quirk, Sarah EllisAbstract:Abstract Background. We examined the effect of a 3-hr training program on physicians′ lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered Counseling to enable patients with elevated lipids to change their dietary patterns. Method. The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training, using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported Nutrition intervention practices, and Counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. Results. After completion of the program the physicians′ use of dietary Counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased x pre = 5.4, x post = 9.2; t = 9.9; P ≤ 0.001). In this regard, there were increases in the use of 7 of the 14 specific Counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale ( x pre = 3.2, x post = 4.0; t = 4.25; P x pre = 3.3, x post = 3.9; t = 3.16; P x pre = 2.7, x post = 4.0; t = 5.29; P x pre = 3.5, x = 4.0; t = 2.63; P
Philip A Merriam - One of the best experts on this subject based on the ideXlab platform.
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comparing food intake using the dietary risk assessment with multiple 24 hour dietary recalls and the 7 day dietary recall
Journal of The American Dietetic Association, 1999Co-Authors: Barbara C Olendzki, Thomas G Hurley, James R Hebert, Sarah Ellis, Philip A Merriam, Rose S Luippold, Linda Rider, Ira S OckeneAbstract:The Dietary Risk Assessment (DRA) is a brief dietary assessment tool used to identify dietary behaviors associated with cardiovascular disease. Intended for use by physicians and other nondietitians, the DRA identifies healthful and problematic dietary behaviors and alerts the physician to patients who require further Nutrition Counseling. To determine the relative validity of this tool, we compared it to the 7-Day Dietary Recall (an instrument developed to assess intake of dietary fat) and to the average of 7 telephone-administered 24-hour dietary recalls. Forty-two free-living subjects were recruited into the study. The 7-Day Dietary Recall and DRA were administered to each subject twice, at the beginning and the end of the study period, and the 24-hour recalls were conducted during the intervening time period. Correlation coefficients were computed to compare the food scores derived from the 3 assessment methods. Correlations between the DRA and 7-Day Dietary Recall data were moderate (r = .47, on average, for postmeasures); correlations between the DRA and 24-hour recalls were lower. The ability of the DRA to assess dietary fat consumption and ease of administration make it a clinically useful screening instrument for the physician when Counseling patients about dietary fat reduction.
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effect of physician delivered Nutrition Counseling training and an office support program on saturated fat intake weight and serum lipid measurements in a hyperlipidemic population worcester area trial for Counseling in hyperlipidemia watch
JAMA Internal Medicine, 1999Co-Authors: Ira S Ockene, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M Saperia, Edward J Stanek, Robert J Nicolosi, Thomas G HurleyAbstract:Objective: To evaluate the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood lowdensity lipoprotein cholesterol levels in patients with hyperlipidemia. Participants and Methods: Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician Nutrition Counseling training; and (3) physician Nutrition Counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3hour training program on the use of brief patientcentered interactive Counseling and the use of an officesupport program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels. Results: Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P,.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial Counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group. Conclusion: Brief supported physician Nutrition Counseling can produce beneficial changes in diet, weight, and blood lipids. Arch Intern Med. 1999;159:725-731
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effect of training and a structured office practice on physician delivered Nutrition Counseling the worcester area trial for Counseling in hyperlipidemia watch
American Journal of Preventive Medicine, 1996Co-Authors: Ira S Ockene, Thomas G Hurley, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M SaperiaAbstract:We examined the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with a structured office practice environment for Nutrition management, on physicians' Counseling practices. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization (the Fallon Clinic) were enrolled into a randomized controlled trial. Physicians were randomized by site into three conditions: (1) usual care, (2) physician Nutrition Counseling training, and (3) physician Nutrition Counseling training plus a structured office practice environment for Nutrition management (prompts and the provision of lipid results and Counseling algorithms). A randomly selected 325 patients were given a 10-item patient exit interview (PEI) assessing whether the physician provided advice; assessed past changes, barriers, and resources; negotiated specific plans and goals; provided patient materials; referred the patient to a dietitian; and developed plans for follow-up. Condition 3 physicians demonstrated significantly greater implementation of the Nutrition Counseling sequence than did physicians in either of the other two conditions (P < .0001). Referrals to Nutrition services were markedly reduced in condition 2, despite PEI scores no different than those in condition 1. Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training. Primary care internists, when provided with both training in Counseling techniques and a supportive office environment, will carry out patient Counseling appropriately. Training alone, however, is not sufficient and may be counterproductive. Medical Subject Headings (MeSH): hypercholesterolemia, diet therapy, coronary disease, health behavior, primary health care, medical education, managed care programs.
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physician training for patient centered Nutrition Counseling in a lipid intervention trial
Preventive Medicine, 1995Co-Authors: Judith K Ockene, James R Hebert, Philip A Merriam, Rose S Luippold, Ira S Ockene, Gordon M Saperia, Mark E Quirk, Sarah EllisAbstract:Abstract Background. We examined the effect of a 3-hr training program on physicians′ lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered Counseling to enable patients with elevated lipids to change their dietary patterns. Method. The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training, using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported Nutrition intervention practices, and Counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. Results. After completion of the program the physicians′ use of dietary Counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased x pre = 5.4, x post = 9.2; t = 9.9; P ≤ 0.001). In this regard, there were increases in the use of 7 of the 14 specific Counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale ( x pre = 3.2, x post = 4.0; t = 4.25; P x pre = 3.3, x post = 3.9; t = 3.16; P x pre = 2.7, x post = 4.0; t = 5.29; P x pre = 3.5, x = 4.0; t = 2.63; P
James R Hebert - One of the best experts on this subject based on the ideXlab platform.
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comparing food intake using the dietary risk assessment with multiple 24 hour dietary recalls and the 7 day dietary recall
Journal of The American Dietetic Association, 1999Co-Authors: Barbara C Olendzki, Thomas G Hurley, James R Hebert, Sarah Ellis, Philip A Merriam, Rose S Luippold, Linda Rider, Ira S OckeneAbstract:The Dietary Risk Assessment (DRA) is a brief dietary assessment tool used to identify dietary behaviors associated with cardiovascular disease. Intended for use by physicians and other nondietitians, the DRA identifies healthful and problematic dietary behaviors and alerts the physician to patients who require further Nutrition Counseling. To determine the relative validity of this tool, we compared it to the 7-Day Dietary Recall (an instrument developed to assess intake of dietary fat) and to the average of 7 telephone-administered 24-hour dietary recalls. Forty-two free-living subjects were recruited into the study. The 7-Day Dietary Recall and DRA were administered to each subject twice, at the beginning and the end of the study period, and the 24-hour recalls were conducted during the intervening time period. Correlation coefficients were computed to compare the food scores derived from the 3 assessment methods. Correlations between the DRA and 7-Day Dietary Recall data were moderate (r = .47, on average, for postmeasures); correlations between the DRA and 24-hour recalls were lower. The ability of the DRA to assess dietary fat consumption and ease of administration make it a clinically useful screening instrument for the physician when Counseling patients about dietary fat reduction.
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effect of physician delivered Nutrition Counseling training and an office support program on saturated fat intake weight and serum lipid measurements in a hyperlipidemic population worcester area trial for Counseling in hyperlipidemia watch
JAMA Internal Medicine, 1999Co-Authors: Ira S Ockene, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M Saperia, Edward J Stanek, Robert J Nicolosi, Thomas G HurleyAbstract:Objective: To evaluate the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood lowdensity lipoprotein cholesterol levels in patients with hyperlipidemia. Participants and Methods: Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician Nutrition Counseling training; and (3) physician Nutrition Counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3hour training program on the use of brief patientcentered interactive Counseling and the use of an officesupport program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels. Results: Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P,.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial Counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group. Conclusion: Brief supported physician Nutrition Counseling can produce beneficial changes in diet, weight, and blood lipids. Arch Intern Med. 1999;159:725-731
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effect of training and a structured office practice on physician delivered Nutrition Counseling the worcester area trial for Counseling in hyperlipidemia watch
American Journal of Preventive Medicine, 1996Co-Authors: Ira S Ockene, Thomas G Hurley, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M SaperiaAbstract:We examined the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with a structured office practice environment for Nutrition management, on physicians' Counseling practices. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization (the Fallon Clinic) were enrolled into a randomized controlled trial. Physicians were randomized by site into three conditions: (1) usual care, (2) physician Nutrition Counseling training, and (3) physician Nutrition Counseling training plus a structured office practice environment for Nutrition management (prompts and the provision of lipid results and Counseling algorithms). A randomly selected 325 patients were given a 10-item patient exit interview (PEI) assessing whether the physician provided advice; assessed past changes, barriers, and resources; negotiated specific plans and goals; provided patient materials; referred the patient to a dietitian; and developed plans for follow-up. Condition 3 physicians demonstrated significantly greater implementation of the Nutrition Counseling sequence than did physicians in either of the other two conditions (P < .0001). Referrals to Nutrition services were markedly reduced in condition 2, despite PEI scores no different than those in condition 1. Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training. Primary care internists, when provided with both training in Counseling techniques and a supportive office environment, will carry out patient Counseling appropriately. Training alone, however, is not sufficient and may be counterproductive. Medical Subject Headings (MeSH): hypercholesterolemia, diet therapy, coronary disease, health behavior, primary health care, medical education, managed care programs.
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physician training for patient centered Nutrition Counseling in a lipid intervention trial
Preventive Medicine, 1995Co-Authors: Judith K Ockene, James R Hebert, Philip A Merriam, Rose S Luippold, Ira S Ockene, Gordon M Saperia, Mark E Quirk, Sarah EllisAbstract:Abstract Background. We examined the effect of a 3-hr training program on physicians′ lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered Counseling to enable patients with elevated lipids to change their dietary patterns. Method. The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training, using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported Nutrition intervention practices, and Counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. Results. After completion of the program the physicians′ use of dietary Counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased x pre = 5.4, x post = 9.2; t = 9.9; P ≤ 0.001). In this regard, there were increases in the use of 7 of the 14 specific Counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale ( x pre = 3.2, x post = 4.0; t = 4.25; P x pre = 3.3, x post = 3.9; t = 3.16; P x pre = 2.7, x post = 4.0; t = 5.29; P x pre = 3.5, x = 4.0; t = 2.63; P
Judith K Ockene - One of the best experts on this subject based on the ideXlab platform.
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effect of physician delivered Nutrition Counseling training and an office support program on saturated fat intake weight and serum lipid measurements in a hyperlipidemic population worcester area trial for Counseling in hyperlipidemia watch
JAMA Internal Medicine, 1999Co-Authors: Ira S Ockene, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M Saperia, Edward J Stanek, Robert J Nicolosi, Thomas G HurleyAbstract:Objective: To evaluate the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood lowdensity lipoprotein cholesterol levels in patients with hyperlipidemia. Participants and Methods: Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician Nutrition Counseling training; and (3) physician Nutrition Counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3hour training program on the use of brief patientcentered interactive Counseling and the use of an officesupport program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels. Results: Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P,.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial Counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group. Conclusion: Brief supported physician Nutrition Counseling can produce beneficial changes in diet, weight, and blood lipids. Arch Intern Med. 1999;159:725-731
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effect of training and a structured office practice on physician delivered Nutrition Counseling the worcester area trial for Counseling in hyperlipidemia watch
American Journal of Preventive Medicine, 1996Co-Authors: Ira S Ockene, Thomas G Hurley, James R Hebert, Philip A Merriam, Judith K Ockene, Gordon M SaperiaAbstract:We examined the effectiveness of a training program for physician-delivered Nutrition Counseling, alone and in combination with a structured office practice environment for Nutrition management, on physicians' Counseling practices. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization (the Fallon Clinic) were enrolled into a randomized controlled trial. Physicians were randomized by site into three conditions: (1) usual care, (2) physician Nutrition Counseling training, and (3) physician Nutrition Counseling training plus a structured office practice environment for Nutrition management (prompts and the provision of lipid results and Counseling algorithms). A randomly selected 325 patients were given a 10-item patient exit interview (PEI) assessing whether the physician provided advice; assessed past changes, barriers, and resources; negotiated specific plans and goals; provided patient materials; referred the patient to a dietitian; and developed plans for follow-up. Condition 3 physicians demonstrated significantly greater implementation of the Nutrition Counseling sequence than did physicians in either of the other two conditions (P < .0001). Referrals to Nutrition services were markedly reduced in condition 2, despite PEI scores no different than those in condition 1. Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training. Primary care internists, when provided with both training in Counseling techniques and a supportive office environment, will carry out patient Counseling appropriately. Training alone, however, is not sufficient and may be counterproductive. Medical Subject Headings (MeSH): hypercholesterolemia, diet therapy, coronary disease, health behavior, primary health care, medical education, managed care programs.
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physician training for patient centered Nutrition Counseling in a lipid intervention trial
Preventive Medicine, 1995Co-Authors: Judith K Ockene, James R Hebert, Philip A Merriam, Rose S Luippold, Ira S Ockene, Gordon M Saperia, Mark E Quirk, Sarah EllisAbstract:Abstract Background. We examined the effect of a 3-hr training program on physicians′ lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered Counseling to enable patients with elevated lipids to change their dietary patterns. Method. The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training, using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported Nutrition intervention practices, and Counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. Results. After completion of the program the physicians′ use of dietary Counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased x pre = 5.4, x post = 9.2; t = 9.9; P ≤ 0.001). In this regard, there were increases in the use of 7 of the 14 specific Counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale ( x pre = 3.2, x post = 4.0; t = 4.25; P x pre = 3.3, x post = 3.9; t = 3.16; P x pre = 2.7, x post = 4.0; t = 5.29; P x pre = 3.5, x = 4.0; t = 2.63; P
