This is a five-year proposal to develop a physician-based nutrition intervention program. The intervention is aimed at changing physician practice behaviors for the purpose of changing patient eating patterns and lowering plasma cholesterol to reduce the risk for coronary heart disease. A multidisciplinary team, including primary care physicians and representatives from the fields of lipidology, clinical trials, health education and evaluation, nutrition and a panel of expert consultants, are collaborating in this effort. The intervention program will be developed in cooperation with primary care physicians and will be tested in their offices. The developmental phase includes development of (1) a simple, self-administered eating patterns assessment tool (EPAT) which will predict average intake of saturated fat and cholesterol and can be used for initiating a specific nutrition intervention protocol; (2) a patient nutrition education program with a major emphasis on defining the type of nutrition message necessary for patient eating behavior change; (3) a protocol for transforming the use of the EPAT and the nutrition message strategies into office protocol; and (4) the appropriate training program for physicians and their staff to facilitate implementation of the nutrition intervention. The entire nutrition intervention program will be field tested to evaluate its overall effectiveness in changing eating patterns and plasma cholesterol. The evaluation design allows for comparison of a usual care physician group, a group where patients have been given the EPAT without physician intervention, a group where physicians administer the EPAT and any intervention program of their choice, and a group where physicians are trained to implement the entire program. Throughout the proposal, there is an integrated data management and analysis plan. The expected goal is to have an effective, efficient nutrition intervention program which can be used by primary care physicians to facilitate change in patient eating behavior and plasma cholesterol.
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