Patient cardiovascular risk self-management: results from a randomized trial of motivational interviewing delivered by practice nurses

Background. To enhance cardiovascular risk management and patients' self-management, a tailored programme to improve cardiovascular risk management was tested in a randomized trial. The presented study concerned secondary analysis. Objectives. To explore the correlations of practice nurses' counselling skills at baseline on chronic illness care (measured with Patient Assessment of Chronic Illness Care questionnaire) and patients' self-management (assessed with Patient Activation Measure) at follow-up and to examine the effect of the tailored implementation programme on chronic illness care and patients' self-management. Methods. A two-arm cluster randomized trial was conducted in 34 general practices in the Netherlands. Counselling skills of practice nurses at baseline were abstracted from audio-taped consultations, which were assessed by Motivational Interviewing Treatment Integrity. Data of 2184 patients with established cardiovascular disease or at high cardiovascular risk were gathered at inclusion and at 6 months follow-up by a composite questionnaire. Multilevel regression analysis was applied, controlling for patient characteristics. Results. Counselling skills of practice nurses were not associated with chronic illness care and patients' self-management scores. At follow-up, patients in the intervention group experienced less chronic illness care and were less activated in disease management than patients in the control group. The most important predictors were patients' age, gender and education level. Conclusions. The logic model underlying the implementation programme needs to be reconsidered, because patient perceptions were neither influenced by nurses' counselling skills nor by other components of the implementation programme.