Synthesis of lessons learned from cardiopulmonary preventive interventions in healthcare practice settings

Purpose: This paper will review and synthesize information from several sources to determine what providers do regarding prevention, and their subsequent effect on patients' cardiopulmonary risk factors: smoking, lipids, physical activity, obesity, and combinations of risk factors. Methods: We review studies investigating interventions to promote providers' (i.e., physicians, nurses, and nutritionists) prevention-enhancing behaviors, and studies investigating the effects of providers' preventive interventions on patients' cardiopulmonary risk factors. Results: Educational programs to improve healthcare providers' preventive intervention knowledge, attitudes, and skills have a significant effect when combined with a system which reminds providers to intervene and gives them the tools to do so. With regard to smoking and lipids, current studies demonstrate significant improvements in providers' use of preventive interventions with patients, and subsequently, improvement in patients' smoking cessation rates and blood cholesterol levels. Comprehensive programs which include providers from several disciplines also have significant effect on patients' smoking and blood cholesterol levels. Randomized clinical trials (RCTs) of physical activity are scarce but support the concept that providers can have an effect on patients' physical activity levels. In general, primary prevention multiple risk factor studies show small, favorable effects in individual risk factors and in overall risk, Using a team approach, secondary prevention studies have demonstrated greater reductions. Conclusions: Traditional education/training programs are most effective for promoting providers' delivery of preventive interventions when combined with enabling strategies (e.g., office reminders), reinforcing strategies (e.g., feedback), and predisposing strategies (e.g., practice guidelines). When healthcare providers intervene, they are effective in helping patients to change cardiopulmonary disease-related behaviors. Interventions that use non-physicians and physicians together have been found to be most effective. It is optimal for physicians, in the context of a comprehensive program, to offer brief counseling to all patients, provide written or audiovisual materials, have available multiple clinic visits or telephone calls to support change, and refer some to specialized providers who can work with them on decreasing risk factors.