Adherence, Goal Setting and Cardiovascular Risk Reduction among the Veteran Population

Date
2009
Authors
Cohen, Shannon
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Kataoka-Yahiro, M.
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Nursing
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University of Hawaii at Manoa
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Purpose: Determine the prevalence of cardiovascular risk factors and to examine the influence of patient adherence and patient-provider goal-setting and decision support on factors related to cardiovascular disease risk among veterans receiving outpatient care. Design: Secondary data analysis of de-identified medical records of 1,865 veterans, aged 18-89 years old, who received outpatient primary care services at least twice over a twoyear time period between 2003-2007 at a Department of Veterans Affairs Medical Center. Descriptive statistics were used to describe the prevalence of cardiovascular risk factors. The association among patient adherence and patient-provider goal setting and decision support on body mass index, HbAlc, and LDL cholesterol was examined using generalized estimating equations with exponential regression. Findings: 1,579 (84.7%) veterans were 50 years or older in 2007,22.9% had an existing diagnosis of cardiovascular disease, 26.2% had diabetes, and 6.6% had both cardiovascular disease and diabetes. Nearly 40% of the sample was considered obese with a BMI >30. Twenty-eight percent had an LDL higher than recommended but risk levels declined from 42.9% high risk cases in 2003 to 24.2% high risk cases in 2007. Over three-quarters of the sample reported a smoking history. Patient-provider goal setting was not a predictor of BMI, however, cholesterol medication prescribed, age, and number of visits was significant. Patient-provider goal setting was a significant predictor of HbAlc and LDL along with educational class attendance, cholesterol medication prescribed, age, and type of health care provider. Conclusions: Veterans in this study were at high risk for cardiovascular disease. Patientprovider goal setting, educational class attendance, cholesterol medication prescribed, age, and type of health care provider were significant predictors of HbAlc and LDL. BMI levels remained steady as weight loss requires a great deal more effort. The gap between behavioral intention and action is a challenge in obesity management. Future prospective studies are needed to further define the relationship between patient adherence and patient-provider goal-setting and decision support and develop culturally sensitive and innovative programs among this population.
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207 pages
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Theses for the degree of Doctor of Philosophy (University of Hawaii at Manoa). Nursing ; no. 5338
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