Patient-centered education in dyslipidemia management: a systematic review
, et | 16 juin 2023
Article Category: Review
Publié en ligne: 16 juin 2023
Pages: 214 - 236
DOI: https://doi.org/10.2478/abm-2022-0026
Mots clés
© 2022 Farhana Fakhira Ismail et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Figure 1.
Summary of studies included
| Eaton (2011) [ |
New England | 2-arm RCT | 4,105 | Patients with regular follow-up and interested in coronary heart disease risk reduction | Primary care clinic |
| Goyer (2012) [ |
Canada | 3-arm RCT | 185 | Patients with at least 2 cardiovascular risk factors | Montreal Clinical Research Institute |
| McDermott (2012) [ |
The United States | 3-arm RCT | 355 | Peripheral arterial disease patients with LDL-C ≥ 70 mg·dL−1 | Medical institution (university) |
| Ockene (1999) [ |
The United States | 3-arm RCT | 1,162 | Patients with blood TC level in the highest 25th percentile and had a previous scheduled visit | Community health center (health maintenance organization) |
| Fortin (2016) [ |
Canada (North America) | 3-arm RCT | 664 | Patients aged 18–75 years with at least 1 chronic conditions or risk factors | Primary care practice |
| Lear (2002) [ |
Canada (North America) | 2-arm RCT | 302 | Patients with ischemic heart disease | Hospital |
| Lin (2012) [ |
The United States | 2-arm RCT | 214 | Patients with poorly controlled diabetes and coronary heart diseases | Hospital (medical center) |
| Allen (2011) [ |
The United States | 2-arm RCT | 525 | Patients with established CVD and LDL-C/BP/HbA1c exceeding target goal | Community health center |
| Babazono, (2007) [ |
Japan | 2-arm RCT | 99 | Patients with high SBP/DBP/HbA1c during annual health checkup | Health center |
| Bosworth (2018) [ |
The United States | 2-arm RCT | 428 | Patients with poorly controlled hypertension and/or hypercholesterolemia | Medical center/hospital |
| Byrne (2020) [ |
The United Kingdom | 2-arm RCT | 212 | Patients prescribed with statins and had TC ≥5 mmol·L−1 | Primary care center |
| Ho (2014) [ |
The United States | 2-arm RCT | 241 | Patients admitted with acute coronary syndrome as the primary reason | Medical center (hospital) |
| Iturralde (2019) [ |
The United States | 2-arm RCT | 647 | Patients with ≥1 uncontrolled CVD risk factors for at least 2 years before | Kaiser Permanente (non-profit integrated healthcare delivery system) |
| Jarab (2012) [ |
Jordan | 2-arm RCT | 156 | Follow-up patients with type 2 diabetes | Hospital |
| Jiang (2007) [ |
China | 2-arm RCT | 167 | Patients who were first hospitalized with either angina pectoris or myocardial infarction | Hospital |
| Maindal (2014) [ |
Denmark | 2-arm RCT | 509 | Patients aged 40–69 years at the time of screening and diagnosis of screening-detected type 2 diabetes | Primary care clinic |
| Mok (2013) [ |
Hong Kong | 2-arm RCT | 82 | Patients diagnosed with myocardial infarction | Hospital |
| Sol (2008) [ |
The Netherlands | 2-arm RCT | 154 | Referred patients with symptomatic vascular diseases | Hospital |
| Zhang (2019) [ |
China | 2-arm RCT | 62 | Patients with history of cardiometabolic syndrome | Medical university-affiliated hospital |
| Daumit (2020) [ |
The United States | 2-arm RCT | 269 | Patients with at least 1 cardiovascular risk factor | Community outpatient clinic |
Summary of impact of interventions
| Eaton [ |
– | – | 0 LDL |
– | – | – |
| Goyer [ |
+ Mental health status |
+ Kilocalories intake |
+ TC |
+ SBP |
+ Reduction in CVD risk score (Framingham Risk Score) |
Difference in intervention group: 9.0 mg·dL−1 |
| McDermott [ |
+ Patient activation |
– | + LDL |
– | + Pharmacotherapy initiation and adjustments |
Difference in intervention group: 18.4 mg·dL−1 |
| Ockene [ |
– | + Reduction in consumption of saturated fats |
0 TC |
+ Weight |
– | Difference in intervention group: 1.98 mg·dL−1 |
| Fortin [ |
– | + Self-monitoring |
– | + BMI |
– | – |
| Lear [ |
0 Self-efficacy |
0 Smoking status |
0 TC |
+ BMI |
+ Higher PTCA procedures |
– |
| Lin [ |
– | + Glucose monitoring |
– | – | + Pharmacotherapy initiation and adjustment rates for antidepressants |
– |
| Allen [ |
+ Perceptions of the quality of chronic illness care |
– | + TC |
+ SBP |
– | Difference in intervention group: 21.6 mg·dL−1 |
| Babazono [ |
– | + Number of steps per day |
0 TC |
0 BMI |
– | Difference in intervention group: 1.4 mg·dL−1 |
| Bosworth [ |
– | – | + TC |
0 SBP |
– | Difference in intervention group: 9.7 mg·dL−1 |
| Byrne [ |
+ Perceived control and understanding of the condition |
0 Medication adherence to statin |
0 TC |
0 SBP |
0 CVD risk score |
TC: difference in intervention group: 12.42 mg·dL−1 |
| Ho [ |
– | + Medication adherence |
0 LDL |
0 SBP |
– | Difference in intervention group: 13 mg·dL−1 |
| Iturralde [ |
+ Patient activation |
0 Statin adherence |
0 LDL |
0 SBP |
0 1 year CVD risk factor |
– |
| Jarab [ |
– | + Medication adherence |
+ LDL |
+ SBP |
– | Difference in intervention group: 10.8 mg·dL−1 |
| Jiang [ |
– | + Medication adherence (at 3 months) |
+ TC |
+ SBP (at 3 months) |
– | Difference in intervention group: 8.1 mg·dL−1 |
| Maindal [ |
+ Patient activation |
0 Physical activity |
+ TC |
0 SBP |
0- to 10-year CVD risk score |
TC: difference between intervention and control groups: 4.32 mg·dL−1 |
| Mok [ |
– | + Reduction in consumption of saturated fats and salted food |
0 TC |
– | – | Difference in intervention group: no difference |
| Sol [ |
0 Total self-efficacy |
– | 0 LDL |
0 SBP |
– | – |
| Zhang [ |
+ Quality of life |
0 Physical activity |
+TG |
+ SBP |
– | TG: difference in intervention group: 14.4 mg·dL−1 |
| Daumit [ |
– | + Smoking status |
0 TC |
0 SBP | + Reduction in 10-year Framingham risk score |
Difference in intervention group: 8.2 mg·dL−1 |
Criteria assessments for studies included
| Eaton [ |
1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Goyer [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| McDermott [ |
1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Ockene [ |
1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Fortin [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Lear [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Lin [ |
1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Allen [ |
1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Babazono [ |
1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Bosworth [ |
1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Byrne [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Ho [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Iturralde [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Jarab [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Jiang [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Maindal [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Mok [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Sol [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Zhang [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Daumit [ |
1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Search strategy for the databases
| 1 | Dyslipidemia |
| 2 | Hyperlipidemia |
| 3 | Hypercholesterolemia |
| 4 | Hypertriglyceridemia |
| 5 | 1 OR 2 OR 3 OR 4 |
| 6 | Patient centered (text word) |
| 7 | Patient centered education |
| 8 | Patient education |
| 9 | Patient empowerment |
| 10 | 6 OR 7 OR 8 OR 9 OR 10 |
| 11 | 6 AND 10 |
Inclusion and exclusion criteria for articles
| ✓ English articles only | ➢ Review article (systematic review and meta-analysis) |
| ✓ RCT | ➢ Articles with study protocol only |
| ✓ Published from inception till April 2021 | ➢ Articles with poor randomization method |
| ✓ Included patient education as the intervention | ➢ Articles with unclear description of patient education |
| ✓ Intervention used PCE with the following criteria: | |
| – Applied SDM (the decision is mutually agreed by the patients and health-care professionals) | |
| – Mentioned patient-centered approaches such as MI | |
| ✓ Articles assessed by the CASP checklist for assessment of study quality |
Summary of interventions
| Eaton (2011) [ |
Physician | 12 months |
4 academic detailing sessions Physicians received patient education toolkit, a computer kiosk with patient activation software, and PDA-based decision support tool Patients were guided via interactive SDM aided by the PDA decision support tool |
Active patient involvement in care plan Individualized care plan |
Physicians received PDA only without the decision support tool and no patient education toolkit |
Theory: chronic care model |
| Goyer (2012) [ |
Nutritionist Psychologist Kinesiologist Nurse Physician | 3 months |
12 weekly group sessions of 3 h between Months 3 and 6 of the study Follow-up sessions every 3 months until the end of the second 2-year protocol |
Active patient involvement in care plan Individualized care plan MI |
Management was left to the family physician. Patients were called after 1 year for address verification and reminder for the 2-year follow up Called for the 2-year assessment |
Theory/model: health belief model, Prochaska stages of change |
| McDermott (2012) [ |
Health counselor | 12 months |
Patient-centered counseling for medication adherence and recommendation to visit the physicians Telephone calls every 6 weeks for 12-month duration advising about medication adherence and encouragement to increase walking activity |
Active patient involvement in care plan Individualized care plan |
Second control arm:
8 telephone calls delivered every 6 weeks No attempts for behavior change Third control arm:
No scheduled telephone calls |
Key mechanism: health-care professional–patient relationship to promote patient activation (patient requested more-intensive lipid-lowering therapy from their physicians) |
| Ockene (1999) [ |
Physician | 12 months |
Physicians received nutrition counseling training with office support program Physicians delivered patient-centered and interactive nutrition counseling assisted with office support program Office support program helped the physicians to provide counseling by providing all necessary materials |
Active patient involvement in care plan Individualized care plan |
Second control arm:
Physicians received nutrition counseling training only Third control arm:
Usual care (not being described further) |
Theory: social learning theory |
| Fortin (2016) [ |
Nurse CDPM professional | 3 months |
Self-management support, patients’ education about risk assessment, and lifestyle changes assisted with printed materials Collaborative care The intervention group received the intervention right away after the baseline measurement |
Active patient involvement in care plan Individualized care plan MI |
Second control arm:
Received similar intervention as intervention group but 3 months after baseline (delayed intervention) Third control arm:
Received no intervention at all for 1 year |
Key mechanism: health-care professional–patient relationship to promote self-management, empowerment, and self-efficacy |
| Lear (2002) [ |
Dietitian Exercise specialist nurse | 48 months |
6 CRPs, 6 telephone follow-ups, 3 lifestyle and risk factor counseling sessions annually and continued for 2 years Patients were counseled about behavior changes and guided to develop individualized goal setting |
Active patient involvement in care plan Individualized care plan |
Return to their family physician’s care and come to the study clinic only to undergo annual outcome assessment Copy of the laboratory results were sent to the participants’ family physicians |
Theory: transtheoretical theory, social cognitive theory |
| Lin (2012) [ |
Nurse Physician | 12 months |
Patient education by nurses, followed by regular follow-up Weekly caseload reviews by physician consultants Monitoring was done by visits or telephone calls initially 2–3 times a month |
Active patient involvement in care plan Individualized care plan |
Patients were advised to consult their primary care physicians Patients can self-refer or be referred for specialty services, including mental health |
Theory: chronic care model |
| Allen (2011) [ |
Nurse Community health worker | 12 months |
Patient education followed by follow-ups. Follow-up frequency depends on participants’ progress Progress reviewed by community health worker Each follow-up session discussed individualized patients’ goals, barriers, strategies, and support to aid patients in achieving the goal |
Active patient involvement in care plan Individualized care plan MI |
Received results of baseline with the recommended goal level Received a pamphlet on controlling risk factors from American Heart Association |
Theory: chronic care model |
| Babazono (2007) [ |
Dietitian Health exercise instructor Public health nurse | 12 months |
Patient education about lifestyle changes Follow-up support, twice a year at patient’s home Health center visits for blood tests at the end of 4 and 6 months |
Active patient involvement in care plan Individualized care plan |
Received result of their blood tests and leaflets |
Model: transtheoretical model |
| Bosworth (2018) [ |
Clinical pharmacist specialist | 12 months |
12 monthly telephone calls emphasizing on medication management, training on home BP monitor, encouragement of self-monitoring of blood glucose, adverse effect monitoring, and medication adherence |
Active patient involvement in care plan Individualized care plan |
Received primary care and CVD management according to the decision of the provider At baseline and 6 months, patients received generic printed educational material on ways for CVD risk reduction |
Model: transtheoretical model |
| Byrne (2020) [ |
Facilitator (health-care professional) | 12 months |
2 education sessions with follow-up support involving 44 weeks of text messages and 2 telephone calls Session 1 focused on risk assessment and role of statin, meanwhile Session 2 focused on lifestyle modification and behavioral control techniques The text messages were automated and contained medication reminders as well as information and advice |
Active patient involvement in care plan Individualized care plan |
Received basic information leaflet Continued treatment with their usual general practitioner for primary prevention of CVD |
Theory: behavior change wheel |
| Ho (2014) [ |
Pharmacist Primary care clinician/cardiologist | 12 months |
Patient education at 1 week and 1 month visit Collaborative care between pharmacist and patient’s primary care clinician and/or cardiologist 2 types of voice messaging (educational and medication refill reminder calls) |
Patient involvement in care plan Individualized care plan |
Scheduled for clinic visit after 1 year for risk assessment |
Model: Wagner chronic care model, medication adherence model |
| Iturralde (2019) [ |
Nurse Pharmacist | 12 months |
Received usual care with group-based behavioral intervention 3 group-based patient activation sessions. These sessions included contacts with the nurses/pharmacists by secure message, telephone calls, or video appointments Development of individualized care plan Live demonstration of electronic patient portals and participants’ role play |
Active patient involvement in care plan Individualized care plan MI |
Received usual care Telephone follow-ups or secure messages through the electronic patient portal |
Theory: chronic care model |
| Jarab (2012) [ |
Clinical pharmacist | 6 months |
Structured patient education and discussion, with provision of booklets Followed by 8 weekly telephone calls by clinical pharmacists. During telephone call, prescription was reviewed and the adherence to the treatment plan was discussed |
Active patient involvement in care plan Individualized care plan MI |
Received usual care by medical and nursing staff, included patient assessment at 3 and 6 months |
Theory/key mechanism: health-care professional–patient relationship to promote patient’s self-management behavior |
| Jiang (2007) [ |
Nurse | 3 months |
12-week CRP divided into 2 phases, which were the hospital-based/family education and home-based rehabilitation care Involvement of family members in the hospital-based and home-based phases Follow-ups through home visits and telephone calls |
Active patient involvement in care plan Individualized care plan |
Received risk assessments together with intervention group at baseline, 3 months, and 6 months |
Key mechanism: health-care professional–patient relationship in providing education to promote change in health behavior and physiological risk parameter |
| Maindal (2014) [ |
Nurse Dietitian Physiotherapist General physician | 3 months |
Received intensive treatment for behavioral change and pharmacological treatments from general practitioners. Also received invitation to take part in the intervention group 12-week patient-centered health education program with 2 individual counseling interviews 8 group sessions focused on action competence, CVD risk, and dietary advice according to individual goal |
Active patient involvement in care plan Individualized care plan |
Received intensive treatment for behavioral change and pharmacological treatments from general practitioners |
Theory: motivation theory |
| Mok (2013) [ |
Nurse | 2 months |
8 weeks of nurse follow-up dietary intervention, including: face-to-face consultations, take-home self-management workbook, and fortnightly telephone follow-ups |
Active patient involvement in care plan Individualized care plan |
Outpatient medical follow-up by cardiologist Standard cardiac rehabilitation provided by hospital-Dietary class within 1 week after diagnosis of myocardial ischemia |
Key mechanism: health-care professional–patient relationship to promote dietary change |
| Sol (2008) [ |
Nurse | 12 months |
Nursing care consisted of (1) self-efficacy promotion and (2) medical treatment of vascular risk factors. Patients were given information and tailored advice based on their conditions Patients were guided for individualized goal setting for lifestyle changes. Patients underwent regular follow-up for weight, BP, and fasting lipid and glucose levels |
Active patient involvement in care plan Individualized care plan |
Scheduled follow-up visit after 1 year for risk factor measurement |
Key mechanism: health-care professional–patient relationship to promote self-efficacy and improvement in vascular risk factors |
| Zhang (2019) [ |
Psychologist Internal medicine specialist | 3 months |
24 workshops that applied SDM; partnership establishment; and patients were supported to have individualized goals |
Active patient involvement in care plan (SDM) Individualized care plan |
General information about cardiometabolic syndrome risk factors Sent weekly text messages. No in-person contacts other than the scheduled measurements |
Key mechanism: Skinner behavior intensified techniques |
| Daumit (2020) [ |
Nurse Physician Health coach | 18 months |
Weekly individualized counseling sessions for the first 6 months and at least every 2 weeks thereafter Collaborative care among health coaches, nurses, and physicians Had point system to reward attendance and behavior change |
Active patient involvement in care plan Individualized care plan MI |
Had assessment during scheduled follow-up at 6 months and 18 months |
Theory/model: behavioral self-management concepts, social cognitive theory, solution-focused therapy |