Cardiovascular Risk Factors and Visiting Nurse Intervention -Evaluation of a Croatian Survey and Intervention Model: the CroHort Study (original) (raw)
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Collegium antropologicum, 2009
The paper describes a visiting nurse led intervention model for the primary and secondary prevention of cardiovascular diseases (CVD) and specificities of its application. Although CVD burden is high in Croatia, the visiting nurse services have not been specifically focused on CVD prevention in the population until now. The intervention model described here is being implemented alongside the second cycle of the Croatian Adult Health Survey (2008 CAHS). The model includes an objective evaluation of respondents' CVD risk factors through quantitative and qualitative analyses, as well as respondents' self-evaluation of risk factors and motivation to change. At the same time, respondents are educated and intervention is evaluated. A 'health booklet' was specifically designed for documentation during one year's follow-up, where both the user and the visiting nurse keep copies of the negotiated targets and strategies set to achieve them. This intervention model has the ...
The Changing Pattern of Cardiovascular Risk Factors: the CroHort Study
Collegium Antropologicum, 2012
Croatia has a long tradition of non-communicable disease prevention, but also obstacles to the implementation of preventive programs related to the general attenuation of public health and primary health care sector. The aim of this study was to determine trends in behavioral and biomedical risk factors and evaluate primary non-communicable disease and cardiovascular prevention. Physical inactivity was a leading risk factor with increasing trend and prevalence of 33. 9% and 38.9% in men and women in 2008. In 2008, obesity was present in 26.1% and 34.1%, and hypertension in 65.8% and 59.7% of men and women. During the follow-up only smoking and alcohol consumption in men decreased significantly, while alcohol consumption and obesity in women, and hypertension in both sexes significantly increased. In the present situation, with the existing trends and environment it will not be possible to stop negative trends. Revitalization of public health activities and primary health care is essential.
The Lancet, 2008
Background Our aim was to investigate whether a nurse-coordinated multidisciplinary, family-based preventive cardiology programme could improve standards of preventive care in routine clinical practice. Methods In a matched, cluster-randomised, controlled trial in eight European countries, six pairs of hospitals and six pairs of general practices were assigned to an intervention programme (INT) or usual care (UC) for patients with coronary heart disease or those at high risk of developing cardiovascular disease. The primary endpoints-measured at 1 year-were family-based lifestyle change; management of blood pressure, lipids, and blood glucose to target concentrations; and prescription of cardioprotective drugs. Analysis was by intention to treat. The trial is registered as ISRCTN 71715857. Findings 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC, respectively. In patients with coronary heart disease who smoked in the month before the event, 136 (58%) in the INT and 154 (47%) in the UC groups did not smoke 1 year afterwards (diff erence in change 10•4%, 95% CI −0•3 to 21•2, p=0•06). Reduced consumption of saturated fat (196 [55%] vs 168 [40%]; 17•3%, 6•4 to 28•2, p=0•009), and increased consumption of fruit and vegetables (680 [72%] vs 349 [35%]; 37•3%, 18•1 to 56•5, p=0•004), and oily fi sh (156 [17%] vs 81 [8%]; 8•9%, 0•3 to 17•5, p=0•04) at 1 year were greatest in the INT group. High-risk individuals and partners showed changes only for fruit and vegetables (p=0•005). Blood-pressure target of less than 140/90 mm Hg was attained by both coronary (615 [65%] vs 547 [55%]; 10•4%, 0•6 to 20•2, p=0•04) and high-risk (586 [58%] vs 407 [41%]; 16•9%, 2•0 to 31•8, p=0•03) patients in the INT groups. Achievement of total cholesterol of less than 5 mmol/L did not diff er between groups, but in high-risk patients the diff erence in change from baseline to 1 year was 12•7% (2•4 to 23•0, p=0•02) in favour of INT. In the hospital group, prescriptions for statins were higher in the INT group (810 [86%] vs 794 [80%]; 6•0%, −0•5 to 11•5, p=0•04). In general practices in the intervention groups, angiotensin-converting enzyme inhibitors (297 [29%] INT vs 196 [20%] UC; 8•5%, 1•8 to 15•2, p=0•02) and statins (381 [37%] INT vs 232 [22%] UC; 14•6%, 2•5 to 26•7, p=0•03) were more frequently prescribed. Interpretation To achieve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to individual countries, which are accessible by all hospitals and general practices caring for coronary and high-risk patients. Funding European Society of Cardiology through an unconditional educational grant from AstraZeneca.
International Journal of Nursing Studies, 2010
Background: Studies have shown that in general patients are positive about cardiovascular prevention delivered by general practitioners. Further, it has been found that care by nurses for the chronically ill leads to even greater patient satisfaction. Objective: The aim of this survey was to answer the following questions: How do patients perceive cardiovascular prevention delivered by the practice nurse? Are patient characteristics and personal health status associated with experiences of received nurse-led care? Design: A cross-sectional survey after completion of a randomised trial. Setting: Six primary health care centres in the Netherlands (25 general practitioners, 6 practice nurses, 30,000 patients). Participants: Included in the randomised trial were 701 patients with at least a 10% risk of fatal cardiovascular disease within 10 years. Patients who visited a cardiovascular specialist more often than once a year and patients with diabetes were excluded from the study. In 90% of the patients it concerned secondary prevention. Half of the patients received nursedelivered care and half received care by the general practitioner. Method: A questionnaire was sent by post to all patients after having received one year of cardiovascular prevention. A dual moderator focus group study was held for the development of the questionnaire. Findings: The response rate was 69%. Patients were more satisfied with nurse-delivered cardiovascular prevention compared to standard care by general practitioners. The majority of patients agreed with positive statements regarding received nurse-led care. Patient characteristics such as age, educational level and gender were significantly associated with patients experiences. Furthermore, a significant association between experiences and personal health status was found. In comparison with patients who did not smoke, smokers would recommend the practice nurse less to others (X 2 = 4.0, p = 0.047), felt more 'rapped on their knuckles' (X 2 = 11.5, p = 0.003), found the consultation more 'awkward' (X 2 = 8.3, p = 0.016) and thought the nurse less understanding of their personal situation (X 2 = 6.4, p = 0.041) and less able to explain clearly (X 2 = 6.5, p = 0.039). Conclusions: The majority of patients responded positively to nurse-delivered cardiovascular prevention. Further improvement could be gained by paying more attention to motivational interviewing. Nurses should approach high risk patients more specifically according to the type of risk factor to be treated. ß
Cardiovascular diseases, risk factors and barriers in their prevention in Croatia
Collegium antropologicum, 2009
Cardiovascular diseases are the leading cause of death in Croatia, with significant regional differences. Despite high mortality rates, high prevalence of various cardiovascular risk factors and well organized public health network, comprehensive system for cardiovascular disease monitoring and interventions does not exist. In this study we analyzed legislation framework and responsibilities of stakeholders relevant for cardiovascular disease surveillance and prevention. According to the international experiences we analyzed characteristics of cardiovascular disease prevention in Croatia and causes of the problems appeared in the preventive programs in Croatia. Analysis showed that primary problem is not inefficiency, but the existence of barriers in preventive activities definition, responsibilities distribution and task implementation. Main cause for such situation is incompatibility of the existing practices in clinical medicine and public health with recommendations from other c...