Integrating Screening and Interventions for Unhealthy Behaviors into Primary Care Practices

Aspy, Cheryl B.; Mold, James W.; Thompson, David M.; Blondell, Richard D.; Landers, Patti S.; Reilly, Kathryn; Wright-Eakers, Linda

doi:10.1016/j.amepre.2008.08.015

Cited by 57 publications

(66 citation statements)

References 47 publications

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“…Ya en el 1985, Rose mostró que los factores de riesgo para la salud casi siempre siguen una distribución normal y defendió un enfoque a la prevención focalizado sobre la población general, en vez de orientado hacia los grupos de riesgo como es habitual. Recientemente se ha enfatizado de nuevo la necesidad de renovar las prácticas en atención primaria incorporando la modificación de las conductas de salud (Aspy et al, 2008;Green, Cifuentes, Glasgow, & Stange, 2008). En la misma línea, la American Academy of Pediatrics (2008) ha destacado la necesidad de abordar la "epidemia" de obesidad que afecta a la infancia mediante programas dirigidos a modificar los hábitos de alimentación y de actividad física (Daniels & Greer, 2008).…”

Section: Conductas De Saludunclassified

Contribuciones de la Medicina Psicosomática a la Medicina Clínica y Preventiva

Montiel

Fava²,

Sonino

2016

AN PSICOL-SPAIN

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Resumen: El trabajo ofrece una revisión actualizada de las principales contribuciones de la Medicina Psicosomática a la medicina clínica y preventiva. Su contenido se basa en los resultados de revisiones sistemáticas, metaanálisis y estudios controlados. La evidencia acumulada indica que la perspectiva psicosomática podría contribuir significativamente a mejorar los resultados de la atención sanitaria, mediante una práctica clínica holística, la evaluación de los factores psicosociales implicados en la vulnerabilidad individual y la integración de intervenciones psicológicas en medicina. Dicha evidencia constituye el terreno ideal para afrontar necesidades emergentes en sanidad, como la gestión de enfermedades crónicas y de síntomas inexplicables, el paciente como productor activo de salud, la prevención temprana y una valoración de resultados que supere el reduccionismo biomédi-co. Palabras clave: medicina psicosomática; biopsicosocial; conducta de enfermedad; atención sanitaria.Title: Contributions of Psychosomatic Medicine to Clinical and Preventive Medicine. Abstract: This paper provides an updated review of the main contributions of Psychosomatic Medicine to clinical and preventive medicine. Metaanalyses, comprehensive reviews and controlled studies were selected. Current advances in the field indicate that health care can be improved by using a psychosomatic approach that takes into account psychosocial factors affecting individual vulnerability, the holistic consideration of patient care, and the integration of psychological interventions in medicine. Consolidated evidence in Psychosomatic Medicine provides the ideal background for dealing with new needs emerging in medical practice, including chronic illness management, somatic unexplained symptoms, the shift in the role of patients from health consumers to actively health producers, primary earlylife prevention, and the appraisal of health outcomes beyond the biomedical reductionism. Keywords: psychosomatic medicine; biopsychosocial; illness behavior; health care. IntroducciónEl término "psicosomático" se ha usado, con frecuencia, para hacer referencia a fenómenos distintos, denotando o generando así cierta ambigüedad en su significado. A veces se ha usado para aludir a un movimiento renovador en Medicina; otras, para referirse a la investigación sobre factores psicológicos implicados en la etiología de las enfermedades físi-cas, para clasificar enfermedades en las que se hipotiza que los factores psicológicos jueguen un papel crucial o, incluso, como etiqueta genérica para denominar todos aquellos sín-tomas somáticos para los que no se dispone de una explicación médica demostrada. Ninguna de estas acepciones es, sin embargo, completa o, al menos, ninguna refleja el concepto de Medicina Psicosomática (MP) que se ha desarrollado en los últimos años . La ambigüedad del término "psicosomático" deriva, probablemente, de la identificación de la MP con algunos de los marcos teóricos y/o métodos de investigación particulares de entre los que han formado parte ...

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Section: Conductas De Saludunclassified

Contribuciones de la Medicina Psicosomática a la Medicina Clínica y Preventiva

Montiel

Fava²,

Sonino

2016

AN PSICOL-SPAIN

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“…The interventions included health information technology interventions, modified or new staff roles, and partnerships with existing community resources. 8,[11][12][13][14] The 10 funded PBRNs were asked to select 3 representative practices and prospectively assist the practices in collecting expenditure data using the instrument while concurrently implementing and evaluating the intervention's effect on patient health behaviors. With the assistance of the PBRN, each practice determined the specific data sources necessary to complete the expenditure instrument and collected the data.…”

Section: Instrument Fielding and Assessmentmentioning

confidence: 99%

“…8 -10 The focus of the initiative was to develop and test whether these interventions improved patients' health behaviors. [11][12][13][14] However, the funders recognized that, for these interventions to be translated outside of the research setting and into the real world, an understanding of expenses incurred by practices to implement and field the interventions was necessary. As a result, credible practice expenditure estimates were systematically collected using a standardized instrument by all 10 PBRNs participating in the second cycle of the initiative.…”

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confidence: 99%

Measuring Primary Care Expenses

Krist¹,

Cifuentes²,

Dodoo³

et al. 2010

The Journal of the American Board of Family Medicine

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Background: Significant investments and effort are being devoted to health care reform, yet little is known about the costs of improvements. Practical tools are needed to allow for systematic assessment of practice expenses. We report here a field trial of a standardized expenditure data collection instrument.Methods: Combining economic and primary care practice consultation, an expenditure data collection instrument was created. The instrument underwent observed feasibility testing and was fielded by 10 practice-based research networks in 30 practices conducting 10 different health behavior change interventions.Results: Start-up and operating expenses were successfully collected for 87% and 97% of the practices, respectively. Data collection time and effort were considerable but acceptable. Three elements were necessary to collect expenditure data: (1) an intervention-specific data collection instrument, (2) a field guide, and (3) economic oversight and assistance. Fully 90% of networks reported that they planned to collect expenditure data in the future and study participation increased the likelihood of their participation in a future expenditure study.Conclusions: It is feasible to systematically collect intervention-specific expenses in primary care using formal expenditure methods. However, most practices and researchers lack the knowledge, expertise, and resources to collect such data independently. Further assistance and education is necessary to obtain reliable information about the expenses to transform and improve primary care. (J Am Board Fam Med 2010;23:376 -383.)

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“…These "local" learning collaboratives (LLCs), defined as a "data-driven group/network of change teams from organizations with commonality of care that work collectively to enhance performance through process improvement," 23(p391) are a scaled down version of more common breakthrough learning collaboratives championed by the Institute for Healthcare Improvement and others. Our experience suggests the LLCs are well-accepted by clinicians and staff, 24 and can achieve the same motivation, competition, and collaborative learning generated in larger collaboratives through more frequent, briefer meetings held in more convenient locations. Optimally, LLCs meet monthly (in person), with fewer than 10 individuals, and have the capacity to generate practice performance data for feedback and comparison, sufficient meeting support, and an agenda with clear objectives.…”

mentioning

confidence: 99%

Local Learning Collaboratives to Improve Quality for Chronic Kidney Disease (CKD): From Four Regional Practice-based Research Networks (PBRNs)

Lipman

Aspy

2016

J Am Board Fam Med

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Background: Four practice-based research networks (PBRNs) participated in a project to increase the diffusion of evidence-based treatment guidelines for chronic kidney disease (CKD). A multicomponent organizational intervention engaged regionally proximal primary care practices in a series of facilitated meetings, referred to as local learning collaboratives (LLCs).Methods: The 2-wave strategy began with 8 practices in each PBRN receiving practice facilitation and subsequently joining an LLC. A sequential mixed-methods design addressed the conduct, content, and fidelity of the intervention; clinicians in 2 PBRNs participated in interviews, and PBRN coordinators reflected on implementation challenges.Results: LLCs were formed in 3 PBRNs, with 121 monthly meetings held across 20 LLCs. Slightly more than half of the participants were clinicians. Qualitative data suggest that clinicians increased the priority for CKD care, improved knowledge and skills, were satisfied with the project, and attempted to improve care. Implementation challenges were encountered and concerns about sustainability expressed.

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Integrating Screening and Interventions for Unhealthy Behaviors into Primary Care Practices

Cited by 57 publications

References 47 publications

Contribuciones de la Medicina Psicosomática a la Medicina Clínica y Preventiva

Contribuciones de la Medicina Psicosomática a la Medicina Clínica y Preventiva

Measuring Primary Care Expenses

Local Learning Collaboratives to Improve Quality for Chronic Kidney Disease (CKD): From Four Regional Practice-based Research Networks (PBRNs)

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