Patient-Motivated Prevention of Lifestyle-Related Disease in Japan: A Randomized, Controlled Clinical Trial
Alan L. Hillman
Background: Preventing lifestyle-related disease requires realistic, cost-effective programs that patients will embrace. We sought to determine whether patient-motivated lifestyle changes would better enhance healthcare outcomes compared with usual care. In addition, we performed an incremental cost-identification analysis of the intervention. Methods: Participants were members of the National Health Insurance in Umi Town, Fukuoka Prefecture, Japan. Ninety-nine patients consented to participate in the study and were then randomized into the Patient-motivated Health Promotion Program group (intervention group) or the conventional support group (control group). The intervention group had a support team - consisting of qualified dietitians, health exercise instructors, and public health nurses - who encouraged patients to set their own goals and to select their own lifestyle improvements. Follow-up support was performed twice during the first year. These follow-up interventions were made in the patients' homes. The control group received the results of their health examinations and instructions on how to enhance exercise via leaflets only. The control group did not receive services from support staff or have the benefit of the two home visits. All patients underwent health center visits for blood testing and re-indoctrination, which were conducted at the end of 4, 6, and 12 months. Main outcome measures included changes in vegetable intake and physical activity (measured as number of steps taken per day). Other health measures included bodyweight, body mass index, blood pressure, cholesterol levels, and General Health Questionnaire. Results: The intervention program significantly increased the number of steps per day, increased the likelihood of consuming >=2 servings of any type of vegetable, and increased the likelihood of consuming green and yellow vegetables after 1 year compared with the control group. However, there were no significant differences between groups with respect to measures of bodyweight, body mass index, blood pressure, cholesterol levels, and General Health Questionnaire score after 1 year. The incremental cost per person-year and the adjusted incremental cost per person-year were Yen27_495 ($US250) and Yen25_819 ($US235), respectively. Conclusions: Health-oriented lifestyle changes can be achieved at nominal additional cost by targeting patient motivation. Patient self-determination in goal-setting should be included in lifestyle-related health programs and program activities should take place, when possible, in patients' homes.
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