TY - JOUR
KW - Adolescent
KW - Child, Preschool
KW - Directive Counseling
KW - Female
KW - Health Behavior
KW - Health Promotion/methods
KW - Health Services Accessibility
KW - Humans
KW - Male
KW - Middle Aged
KW - Primary Health Care/methods
KW - Referral and Consultation/organization & administration
KW - Risk Assessment
KW - United States
AU - D. J. Cohen
AU - B. A. Balasubramanian
AU - N. F. Isaacson
AU - E. C. Clark
AU - R. S. Etz
AU - B. F. Crabtree
A1 - 
AB - PURPOSE: We wanted to examine how coordinated care is implemented in primary care practices to address patients' health behavior change needs. METHODS: Site visit notes, documents, interviews, and online implementation diaries were collected from July 2005 to September 2007 from practice-based research networks (PBRNs) participating in Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks (P4H). An iterative group process was used to conduct a cross-case comparative analysis of 9 interventions. Published patient outcomes reports from P4H interventions were referenced to provide information on intervention effectiveness. RESULTS: In-practice health risk assessment (HRA) and brief counseling, coupled with referral and outreach to a valued and known counseling resource, emerged as the best way to consistently coordinate and encourage follow-through for health behavior counseling. Findings from published P4H outcomes suggest that this approach led to improvement in health behaviors. Automated prompts and decision support tools for HRA, brief counseling and referral, training in brief counseling strategies, and co-location of referral with outreach facilitated implementation. Interventions that attempted to minimize practice or clinician burden through telephone and Web-based counseling systems or by expanding the medical assistant role in coordination of health behavior counseling experienced difficulties in implementation and require more study to determine how to optimize integration in practices. CONCLUSIONS: Easy-to-use system-level solutions that have point-of-delivery reminders and decision support facilitate coordination of health behavior counseling for primary care patients. Infrastructure is needed if broader integration of health behavior counseling is to be achieved in primary care.
BT - Annals of family medicine
C5 - HIT & Telehealth; Education & Workforce
CP - 5
CY - United States
DO - 10.1370/afm.1245
IS - 5
JF - Annals of family medicine
N2 - PURPOSE: We wanted to examine how coordinated care is implemented in primary care practices to address patients' health behavior change needs. METHODS: Site visit notes, documents, interviews, and online implementation diaries were collected from July 2005 to September 2007 from practice-based research networks (PBRNs) participating in Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks (P4H). An iterative group process was used to conduct a cross-case comparative analysis of 9 interventions. Published patient outcomes reports from P4H interventions were referenced to provide information on intervention effectiveness. RESULTS: In-practice health risk assessment (HRA) and brief counseling, coupled with referral and outreach to a valued and known counseling resource, emerged as the best way to consistently coordinate and encourage follow-through for health behavior counseling. Findings from published P4H outcomes suggest that this approach led to improvement in health behaviors. Automated prompts and decision support tools for HRA, brief counseling and referral, training in brief counseling strategies, and co-location of referral with outreach facilitated implementation. Interventions that attempted to minimize practice or clinician burden through telephone and Web-based counseling systems or by expanding the medical assistant role in coordination of health behavior counseling experienced difficulties in implementation and require more study to determine how to optimize integration in practices. CONCLUSIONS: Easy-to-use system-level solutions that have point-of-delivery reminders and decision support facilitate coordination of health behavior counseling for primary care patients. Infrastructure is needed if broader integration of health behavior counseling is to be achieved in primary care.
PP - United States
PY - 2011
SN - 1544-1717; 1544-1709
SP - 406
EP - 415
EP - 
T1 - Coordination of health behavior counseling in primary care
T2 - Annals of family medicine
TI - Coordination of health behavior counseling in primary care
U1 - HIT & Telehealth; Education & Workforce
U2 - 21911759
U3 - 10.1370/afm.1245
VL - 9
VO - 1544-1717; 1544-1709
Y1 - 2011
ER -