Prevention of vascular disease in general practice: Health Improvement and Prevention Study (HIPS)

Project Coordinator

Mahnaz Fanaian

Chief Investigators

Mark Harris

Associate Investigators

David Lyle, Gawaine Powell Davies, Suzanne McKenzie, Megan Passey, Gaynor Heading, Chris Tzar, Liz Devlin, Kate Purcell, Nick Zwar, Upali Jayasinghe, Qing Wan, Cheryl Amoroso, Rachel Laws

Rationale

Chronic diseases such as heart disease, stroke and diabetes contribute greatly to the burden of disease in Australian society. Prevention of these conditions is a high priority for the health system. There is increasing evidence for the effectiveness of interventions to prevent chronic disease in those at high risk. However the feasibility of intervening through general practice and other existing services has not been demonstrated. The findings of this research will help to inform Australian and State health policy especially the preventive care initiatives recently announced by the Council of Australian Governments. It will also inform practice leading to better guidelines for general practice preventive care, better support for general practice to provide preventive care for patients at risk of chronic disease and better support for patients to reduce their risk of chronic disease by changing their behaviour.

Aims

The study aims to evaluate the impact of recalling patients to general practice for a visit to assess their risk of chronic disease and to help them to lower their risk by changes to smoking, diet, alcohol consumption and physical activity behaviours as well as pharmacological management of their blood pressure and cholesterol.

Objectives

1. To develop the capacity of general practices to identify patients at high risk for developing vascular disease (diabetes, cardiovascular disease or renal disease) in general practice.

2. To support practices to provide interventions to reduce patients’ risk of vascular disease through behavioural interventions in general practice or in services to which patients can be readily referred in general practice.

3. To evaluate the impact of these interventions on change in behavioural and physiological risk factors of high risk patients in general practice

4. To explore the relationship between psychological distress, other risk factors for cardiovascular disease and the study interventions

Design and Method

This project will be conducted as a stratified randomized controlled trial with randomisation at the level of practices within Division strata. Few instruments is going to be used at practice level, including GP and staff questionnaires and interviews and at the patient level, including questionnaires, medical record audit, and blood test.

After baseline data collection from 32 practices and their staff, practices will be randomized into the intervention or the control group (16 in each group).Practices in the intervention group will receive training, practice visits, resources, and referral pathways to enable them to invite eligible patients to attend the practice for an assessment and management of their risk factors. This will include provision of education materials, support for behaviour change, referral to Allied Health (dietician / exercise physiologist) and group educational program: “CHANGE for HIPS” and follow up.

The intervention will be undertaken by the researchers for the practices, and by clinician, for the patients (health check). In each practice 160 eligible patients, who have attended the practice in the past 12 months, do not have existing diabetes, heart or renal disease, and are aged 55 -64 or aged 40-54 with hypertension or hyperlipidaemia will be invited to participate. Data will be collected at baseline, 6 months, and 12 months.