Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment

Abstract

PURPOSE To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices.METHODS Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as "at risk" or "healthy" for each factor, and patients indicated their readiness to change and/ or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices.RESULTS On average, patients had 5.8 (SD = 2.12; range, 0-13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important.CONCLUSIONS Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change.

The impact of behavioral and mental health risk assessments on goal setting in primary care

“…While less common, a sizable minority of patients had alcohol (23.8 %), tobacco (23.8 %), illegal drug use (3.2 %), anxiety (15.5 %), and depression risks (8.9 %). These results have been previously detailed [5].…”

“…While the study methods, implementation findings, and frequency of unhealthy behaviors and mental health risks have been previously reported, the study design is detailed below [5,[28][29][30]. The study was approved by the Virginia Commonwealth University (VCU) (#HM12746), University of California, Los Angeles (#12-0017900), and five other participating institutional review boards.…”

“…Unhealthy behaviors and mental health issues cause significant morbidity and mortality [1][2][3][4][5]. Despite the ubiquity of these conditions, they often go unrecognized and untreated.…”

Roles of Physicians and Health Care Systems in “Difficult” Clinical Encounters

“…Even sophisticated interventions targeting psychosocial care are more likely to fail when time, reimbursement, and resources are lacking. For example, a recent trial of a structured behavioral/mental health risk assessment intervention in primary care clinics was successful in its goals of identifying many clinically relevant problems and triaging care but was ultimately found to be too time-consuming to be sustainable in real-world practice [47,48].…”

In This Issue: Research Briefs and New Clinical and Policy Insights

“…Using the My Own Health Report (MOHR) assessment and feedback system to support selective counseling and goal setting, the authors find that patients have an average of 6 unhealthy behaviors and mental health risk factors, but only want to change or discuss about 1 of each. 4 This topic, which has implications for real-world practice, is featured in the Annals Journal Club. 5 The evaluation of the MOHR intervention pays attention to pragmatic factors that are seldomly studied or reported.…”