by Jared Reed  

Complex interventions which build patient self-confidence have been shown to significantly reduce hospital admissions rates for those with coronary heart disease, new research from Northern Ireland suggests.  

The randomised controlled trial involved 900 patients from around 50 general practices in Northern Ireland. The intervention group received motivational interviewing and targets for lifestyle change over 18 months. Practices also received training in prescribing and behaviour change. Control patients received usual ongoing care from their GP.  

The intervention patients were 56% less likely to be admitted to hospital with coronary heart disease over the study’s duration when compared with the control group. For every 100 patients undergoing the intervention, 15 fewer admissions could be expected over an 18 month period, write the authors in the BMJ (2009; 339: b4220).  

However there were no significant improvements in cholesterol concentration, management of blood pressure, or change in physical or mental health status.  

This may be due to a “ceiling effect” from improved secondary management of cardiovascular disease in primary care seen in recent years in Northern Ireland, the authors say. However the study was the first to report a significant difference in cardiovascular hospital admissions from interventions; previous systematic reviews had acknowledged the potential, but few actually reported this outcome.  

Despite the absence of changes to physiological or lifestyle variables in the intervention, the authors suggest that the results were possibly due to improved patient efficacy in managing their own chronic condition, as observed in previous studies.