The proposed study addresses key issues in the implementation of the Adult Treatment Panel Guidelines of the National Cholesterol Education Program in medical practices in rural areas. It recognized the many practical constraionts in providing treatment for elevated blood cholesterol including organization for preventive practice, the preparedness and perceived difficulty of dietary intervention, and the practical constraints of nutrition counseling. To address these issues, the project will develop and test three programs based on NCEP guidelines and patient education materials to facilitate cholesterol reduction. A minimal assistance model (control condition) based on available NCEP physician and patient education materials will be tested. This treatment will be compared to a management assistance model (Treatment 1) which includes consultation to establish a cholesterol office management system, a physician and clinic staff training component in dietary counseling and drug management. A third condition (Treatment 2) combines the above strategies with a home-based learning guide for patients. Tjhe home guide will be supplemented by regular mail follow-up with those patients enrolled. The scientific design of the study involves 15 clinics randomized to the three treatment conditions. A chart survey will access the level of compliance of the NCEP recommendations before and after the interventions. A patient cohort survey will be used to detect the effect of the different treatments on patient behavior and blood cholesterol levels including a selfreported assessment of eating pattern change (Eating Pattern Assessment Tool). A laboratory standardization program will seek to improve the quality of measurement in all clinics. Program costs will be documented and compared to outcomes.
