This study aimed to evaluate the effectiveness of motivational interviewing (MI) conducted by general practitioners to improve lipid levels in patients with dyslipidemia compared to standard care. Over one year, 227 patients were randomized to GPs trained in MI or usual care. Both groups saw reductions in cholesterol and triglycerides from initial to final visits, with no significant differences between groups. However, MI led to greater increases in patient physical activity levels compared to usual care. MI also resulted in less frequent lipid-lowering medication prescribing.

1. Julia Bóveda José M ª Bosch
Nieves Barragán José A. Prados
Manuel Campíñez Luis A. Pérula
Effectiveness of motivational
interviewing in patients with
dyslipidemia treated in primary care
consultations: randomized controlled
trial by cluster (Dislip-EM study)
ICMI 2014 Amsterdam

2. Objective of the study
To verify the effectiveness of a multifactorial
intervention based on motivational intervention by
General Practitioners (GPs) trained in motivational
interviewing (MI), to improve the control of lipid
levels in patients with dyslipidemia, compared with
standard medical advice.

3. Multicenter, open, controlled and randomized
cluster, with two parallel arms formed by two
groups of population with a follow-up over 12
months in primary health care.
Study design

4. 25 Primary
Health
Centers
located in
four regions
of Spain.
Study site

5. • 227 adults aged 40 to 75 years with uncontrolled
dyslipidemia in situation of primary prevention of
cardiovascular disease, captured by their GPs with
consecutive sampling.
Study subjects

6. • 38 GPs were randomized to an intervention with their patients based on MI
or informative advice usual.
• MI was delivered in the Experimental Group (EG), and usual intervention in
the Control Group (CG).
• A specific training plan was designed and implemented in the EG.
• The fidelity of the MI intervention was checked with video recordings of
real consultations with a scale designed and validated in this study (EVEM
questionnaire).
• Follow-up: 1 year.
Intervention

7. Both Groups GPs:
Explained guide clinical
performance in
dyslipidemia and
training video
recording
Workshop
training MI 16h
Booster training: micropills,
videorecording feedback with
expert…
No specific training in MI
EVEM
questionnaire
Control
Group
Intervention
Group
Performance in GPs

8. • Main outcome measures :
• Reduction of lipid levels: total cholesterol, LDL-cholesterol,
Trglycerides.
• Other outcomes variables:
• Reduction of cardiovascular risk
• Degree of improvement in diet
• Increase of physical activity and weight loss in overweight
patients.
Determinations

9. TARGET POPULATION
STUDY POPULATION
Patients attending health centers and meet inclusion
criteria:
Adults 40-75 years old, both sexes with
Dyslipidemia
Exclusion criteria:
• Secondary dyslipidemia or with lipid-lowering
drug therapy
•CVD. Diabetes. Severe COPD. Severe renal or
hepatic disease
•Mental illness or substance abuse
•Be sick for an extended period
•Pregnancy or lactation
Randomisation
38 GPs
(n=436 patients)
EXPERIMENTAL GROUP
Inical evaluation
CONTROL GROUP
Inical evaluation
Intervention
MOTIVATIONAL INTERVIEWING
Intervention
USUAL CARE
Monitoring, assessment and motivational
intervention at
2, 4, 8 and 12 meses
Level blood lipids and CV risk
Monitoring, assessment and usual care at
2, 4, 8 and 12 meses
Level blood lipids and CV risk
Data analysis
Conclusions
TRAINING
MI

10. • An intention to treat analysis has been conducted. To check the
effect of the intervention a comparison of means test (ANOVA,
Kruskal-Wallis) and proportions (Chi-square, McNemar) was used,
and a multivariate analysis was done. Using Multiple Linear
Regression or Logistic Regression (p ≤ 0.05).
Statistical Analysis

11. Results
Flowchart of
included
general
practitioners
and patients

12. Evolution of the mean levels of Total Cholesterol
throughout the study by groupTotalCholesterol
mg/dl
Visits
F=0,021; p=0,996

13. Evolution of the mean levels of LDL- cholesterol
throughout the study by groupLDLCholesterol
mg/dl
Visits
F=0,067; p=0,977

14. Evolution of the mean levels of Triglycerides
throughout the study by groupTriglycerides
mg/dl
Visits
F = 0,216; p=0,886

15. Lipid disorder type at the beginning and end of
the study

16. CV risk score: evolution for groups

17. Evolution weight grades

18. Bode Mass Index in obese and overweight
patients
(F=0,567, p=0,452

19. Initial and final level of physical activity
groups (IPAQ)
Low
Medium
High
Chi square =23,3; p<0.01

20. Score questionnaire mediterranean diet
Diet questionnaire score
Score ≥ 9: high compliance

21. Use of lipid-lowering drugs
Chi square= 5,042, p=0,025

22. Conclusions
1. An approach based on Motivational Interviewing conducted by
primary care physicians aimed at improving the lipid profile in
patients with dyslipidemia, has not proven to be more effective
than usual intervention.
2. Both Motivational Interviewing and the usual care, significantly
reduces total cholesterol, LDL cholesterol, triglycerides and
cardiovascular risk after a one-year monitoring program.
3. Motivational Interviewing gets to make the patients increase
their level of physical exercise to a greater degree than the
usual approach.
4. Professionals who perform a motivational approach use less
lipid-lowering drugs than the control group in patients with
dyslipidemia.

23. This project has been funded by the Consejería de Salud de la Junta de Andalucía (PI-0100/2008, resolution No. BOJA. 12th
January 20, 2009), and has received a grant from the Spanish Society of Family and Community Medicine (Helps for doctoral
theses Isabel Fernández 2011).