Although new dietary recommendations have been established for intervening with those individuals above the 75th percentile in cholesterol levels, substantial questions still remain concerning effective methods to intervene with this large segment of the population. Even though primary care providers have generally not been active in promoting primary and secondary prevention interventions, including nutritional programs, as a result of their contact and influence with the population, acceptable means of promoting their attention to dietary methods may prove a viable method of obtaining nutritional changes among moderate and high risk patients. The overall aim of this proposed three-year project is to evaluate the acceptability, efficacy, and cost-effectiveness of three different models for implementing dietary intervention programs into community physicians' practices to treat individuals who are identified as being at moderate and high risk based on serum cholesterol levels. This project proposes to work with already established County Health Councils and Country Health Departments in Alabama. A community awareness program and Continuing Medical Education programs will be conducted. A total of 90 physician practices will be recruited and randomized in a delayed treatment control design to receive one of three logistical models for implementing nutritional programs for elevated cholesterol levels, including: 1) providing physicians with a community nutrition referral resource; 2) providing physicians with a nutrition referral resource who will conduct the nutritional intervention from the physicians' practice; and 3) providing physicians and their nurses with materials and training to provide the nutritional intervention by themselves. This randomized design will facilitate making comparisons between the interventions as well as providing an intervention versus no intervention comparison with the delayed intervention group serving as a no-treatment comparison group during the delay period. Additional data will be collected about billing and third- party reimbursement patterns for nutritional programs for hypercholesterolemia from other physician practices in Alabama as a way of assessing these patterns for future potential lobbying efforts. The project's investigative team includes experts in the areas of behavioral change, preventive medicine, nutrition, lipid research, public health, medicine, biostatistics, and health economics.
