Schumacher Tracy L, Jansson Anna, Herbert Jaimee, Clarke Erin D, Alderton Carissa, Milson Penny, Oldmeadow Christopher, Brown Leanne J, Rollo Megan E, Williams Annabelle, Nutr M Com, Guppy Michelle, Boyle Andrew, Ramanathan Shanthi, May Jennifer, Attia John, Collins Clare E
Department of Rural Health, College of Health Medicine and Wellbeing, University of Newcastle, Tamworth, NSW, 2340, Australia.
Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
BMC Health Serv Res. 2025 Jul 16;25(1):956. doi: 10.1186/s12913-025-13096-8.
To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth.
The study was a 12-month pragmatic cluster randomised controlled trial. All primary care practices (PCPs) within a large rural region were invited to participate, with enrolled practices stratified based on rurality and practice size. Patients at moderate to high CVD risk were recruited via practices. Usual care (UC) was provided by the patient's general practitioner (GP). In addition to UC, the intervention group received two hours of MNT telehealth (video calls) consultations from an APD during five sessions over 6 months. The primary outcome was total serum cholesterol. Secondary outcomes included LDL cholesterol, triglycerides, blood glucose control, blood pressure, weight and waist circumference. Changes were analysed using Bayesian linear mixed models and posterior probability.
Sixteen PCPs recruited 132 eligible participants (n = 91 intervention, n = 41 UC), with 79% (72/91) and 80% (33/41) respectively completing a primary or secondary outcome. No significant differences were found between groups for total cholesterol, LDL cholesterol or blood pressure at 12-months. However, the intervention group had significant improvements in blood glucose control (HbA1c: -0.16%, 95%CI: -0.32, -0.01) and decreased body weight (-2.46 kg, 95%CI: -4.54, -0.41) compared to UC at 12-months.
Results indicate that two hours of MNT delivered by an APD via telehealth is a synergistic adjunct therapy to support the usual care provided by GP, with benefits continuing to 12-months.
降低澳大利亚新南威尔士州农村地区初级保健医生评估的成年人心血管疾病（CVD）风险。医学营养治疗（MNT）由注册执业营养师（APD）通过远程医疗提供。
该研究是一项为期12个月的实用整群随机对照试验。邀请了一个大农村地区内的所有初级保健机构（PCP）参与，根据农村程度和机构规模对入选机构进行分层。通过这些机构招募中度至高度CVD风险的患者。常规护理（UC）由患者的全科医生（GP）提供。除UC外，干预组在6个月内分5次接受了APD进行的两小时MNT远程医疗（视频通话）咨询。主要结局是总血清胆固醇。次要结局包括低密度脂蛋白胆固醇、甘油三酯、血糖控制、血压、体重和腰围。使用贝叶斯线性混合模型和后验概率分析变化情况。
16个PCP招募了132名符合条件的参与者（n = 91干预组，n = 41 UC组），分别有79%（72/91）和80%（33/41）完成了主要或次要结局。12个月时，两组在总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）或血压方面未发现显著差异。然而，与UC组相比，干预组在12个月时血糖控制（糖化血红蛋白：-0.16%，95%CI：-0.32，-0.01）有显著改善，体重下降（-2.46 kg，9%CI：-4.54，-0.41）。
结果表明，APD通过远程医疗提供的两小时MNT是一种协同辅助治疗，可支持GP提供的常规护理，且益处持续至第12个月。
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