A Physician Counseling Approach for the Improvement of Cardiovascular Risk Factor Control in Ecuador

We will assess the feasibility of an evidence-based patient-centered counseling plus office support program intervention model to improve the ability of Ecuadorian primary care providers (PCPs) to reduce their patients’ CVD risk. In a two-year study we will randomize, by site, 32 PCPs and 200 of their patients free of CVD but at high risk of diabetes to either an intervention (IC) or usual care (UC) condition. The goal is to reduce the high risk of cardiovascular disease to which these patients are subject. Feasibility will be measured by level of implementation of a patient-centered counseling algorithm and office support system as assessed by Patient Exit Interviews (PEIs). We also will assess patient satisfaction with the intervention, as well as the effect of the intervention on patients’ risk factors, including: improvement in LDL, weight, fasting blood sugar, HgbA1C and insulin resistance (HOMA); and self-reported health behaviors: diet, physical activity, and medication adherence. The study will be powered for change in PEI and LDL. The project will be a collaboration between the University of Massachusetts Medical School and the Universidad de las Américas Medical School in Quito, Ecuador. Disseminatable products of the study will include a validated patient-centered physician counseling training package as well as all of the ancillary materials provided as office support for the physician seeing at-risk patients.