UMMS Affiliation

Department of Medicine, Division of Cardiovascular Medicine; Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center

Publication Date


Document Type



Behavioral Medicine | Behavior and Behavior Mechanisms | Cardiovascular Diseases | Community Health and Preventive Medicine | Medical Education | Preventive Medicine | Primary Care | Public Health


Objective: To assess the feasibility of implementing a physician-based, patient-centered counseling intervention model in Ecuador to improve the ability of primary care physicians (PCPs) to reduce cardiovascular disease (CVD) risk factors among patients.

Methods: This was a randomized clinical trial conducted in primary care clinics in Quito in 2014 - 2016. Participants included 15 PCPs and their adult patients at high risk of developing type-2 diabetes. A physician-based and patient-centered counseling program was delivered to eight PCPs. Seven PCPs who did not receive the training comprised the control group. The patient experience was assessed by a patient exit interview (PEI). Assessment of the patient's anthropometrics, blood pressure, and blood biochemistry parameters were conducted. Changes within and between groups were estimated utilizing chi-square, ANOVA, paired t-tests, and coefficient with intervention.

Results: A total of 197 patients participated, 113 in the intervention care group (ICG) and 84 in the usual care group (UCG); 99 patients (87.6%) in the ICG and 63 (75%) in the UCG completed the study. Counseling steps, measured by the PEI, were significantly higher in the ICG (8.9+/-1.6 versus 6.6+/-2.3; P = 0.001). Comparison of the estimated difference between the ICG and the UCG showed greater decreases in HbA1c and total cholesterol in the ICG. Within the ICG, there were significant improvements in weight, BMI, HbA1C, total cholesterol, and LDL-cholesterol.

Conclusions: Training PCPs in a patient-centered behavioral intervention for CVD risk factor reduction is feasible and efficacious for reducing CVD risk factors in Ecuador. Developed and developing countries alike could benefit from such an intervention.


Cardiovascular diseases, Ecuador, blood pressure, cholesterol, HDL, cholesterol, LDL, diabetes mellitus, type 2, health human resource training

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DOI of Published Version



Rev Panam Salud Publica. 2018 Sep 24;42:e139. doi: 10.26633/RPSP.2018.139. eCollection 2018. Link to article on publisher's site

Journal/Book/Conference Title

Revista panamericana de salud publica = Pan American journal of public health

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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.