Office system interventions supporting primary care–based health behavior change counseling

Dickey, Larry L.; Gemson, Donald H.; Carney, Patricia A.

doi:10.1016/s0749-3797(99)00083-5

Cited by 63 publications

(38 citation statements)

References 43 publications

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“…One item assessed the recommendation of breast self-examination (BSE) by the patient. Physicians were asked about the perceived barriers to breast cancer screening, using 8 items, 27,52 including; no medical indication, low yield, risk of radiation, resistance by patients, cost of the test, causing unnecessary worry for patients, the risk of false positives, and other (ie, patient discomfort, patient pain, prefer female provider, frequent lumps). The number of barriers was summed.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of Academic Detailing on Breast Cancer Screening among Primary Care Physicians in an Underserved Community

Gorin¹,

Ashford²,

Lantigua³

et al. 2006

The Journal of the American Board of Family Medicine

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Background: Urban minority groups, such as those living in northern Manhattan and the South Bronx, are generally underserved with regard to breast cancer prevention and screening practices. Primary care physicians are critical for the recommendation of mammography and clinical breast examinations to their patients.Design: Two medically underserved communities were matched and block randomized. The aim of the study was to assess the efficacy of academic detailing in increasing recommendations for breast cancer screening in community-based primary care physicians.Setting/Participants: Ninety-four primary care community-based (ie, not hospital-based) physicians in northern Manhattan were compared with 74 physicians in the South Bronx who received no intervention.Intervention: Intervention participants received multicomponent physician-directed education, academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer.Main Outcome Measures: We administered interviews to ask about primary care physicians' recommendation of mammography and clinical breast examination. They were also queried about their knowledge of major risk factors and perceived barriers to breast cancer screening. We conducted medical audits of 710 medical charts 2 years before and after the intervention.Results: Using a mixed models linear analysis, we found a statistically significant intervention effect on the recommendation of mammography and clinical breast examination (according to medical audit) by female patients age 40 and over. Intervention group physicians correctly identified significantly more risk factors for breast cancer, and significantly fewer barriers to practice, than did comparison physicians.Conclusions: We found some evidence of improvement in breast cancer screening practices due to academic detailing among primary care physicians practicing in urban underserved communities.

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Section: Methodsmentioning

confidence: 99%

Effectiveness of Academic Detailing on Breast Cancer Screening among Primary Care Physicians in an Underserved Community

Gorin¹,

Ashford²,

Lantigua³

et al. 2006

The Journal of the American Board of Family Medicine

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“…The CADA is a logical companion to structured health risk assessments (HRAs), which are now increasingly common. 36 Whereas a health risk assessment assesses the "what" of patient behavior, the CADA helps inform the "why," shining light on circumstances that undermine the effectiveness of standard interventions. For example, a recent article evaluating the outcomes of a robust HRA implementation noted that relatively few patients were interested in behavior change.…”

Section: Discussionmentioning

confidence: 99%

Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions, Behaviors, and Body Mass Index

et al. 2016

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PURPOSE Current strategies for improving diet and activity patterns focus on encouraging patients to make better choices, but they meet with limited success. Because the choices people make depend on the choices they have, we examined how practical opportunities for diet and physical activity shape behavioral intentions and achieved behaviors.METHODS Participants included 746 adults who visited 8 large primary care practices in the Residency Research Network of Texas in 2012. We used structural equation models to confirm factor structures for a previously validated measure of practical opportunities, and then modeled achieved diet (Starting the Conversation -Diet questionnaire), physical activity (International Physical Activity Questionnaire), and BMI as a function of opportunities (classified as either resources or conversion factors that influence use of resources), behavioral intentions, and demographic covariates. RESULTSIn path models, resources (P <.001) and conversion factors (P = .005) predicted behavioral intentions for activity. Conversion factors (P <.001), but not resources, predicted diet intentions. Both activity resources (P = .01) and conversion factors (P <.001) were positively associated with weekly activity minutes. Diet conversion factors (P <.001), but not diet resources (P = .08), were positively associated with diet quality. The same patterns were observed for body mass index (BMI). Socioeconomic gradients in resources and conversion factors were evident.CONCLUSIONS Individuals' feasible opportunities for healthy diet and activity have clinically meaningful associations with intentions, achieved behaviors, and BMI. Assessing opportunities as part of health behavior management could lead to more effective, efficient, and compassionate interventions. Ann Fam Med 2016;14:109-116. doi: 10.1370/afm.1886. INTRODUCTIONG lobal shifts in diet and physical activity patterns 1 have sharply increased obesity prevalence over the past 30 years 2 and are leading causes of preventable morbidity and mortality. 3,4 Effective population and clinical interventions offer great potential to reduce this burden, yet progress has been slow because behaviors are shaped by a complex set of multilevel determinants. 5 Despite the complex genesis of behaviors, clinical assessment and intervention has narrowly focused on individuals' behavioral intentions and motivation, 6,7 with modest success. 8 As a result, clinicians have limited confidence in their ability to manage obesity and its linked behaviors, 9,10 leading to declining rates of diagnosis and treatment. 14 Evaluating opportunity is therefore necessary to an understanding of the connections among environmental contexts, personal factors, behavioral intentions, and achieved behaviors. Conversely, framing behaviors as decontextualized "lifestyles" 15 risks missing important determinants of health behavior.In previous papers, we offered a theoretical 16 and empirical case 17 for examining health behavior using the capability approach, 18 a theory of socia...

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“…This article shows that prescribing the latest drug may help patients less than adopting offi ce systems to ensure that all eligible individuals receive recommended care. 76 Clinicians should look past catchy drug advertisements and the promotions of pharmaceutical representatives to consider whether the incremental magnitude of benefi t offered by newer agents crosses the break-even point ( Figure 1).…”

Section: Competing Agendasmentioning

confidence: 99%

The Break-Even Point: When Medical Advances Are Less Important Than Improving the Fidelity With Which They Are Delivered

Woolf

Johnson²

2005

The Annals of Family Medicine

182

121

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Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fi delity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealistic increases in effi cacy to do more good than could be accomplished by improving fi delity. In 2 examples (the development of antiplatelet agents and statins), we show that enhanced effi cacy failed to achieve the health gains that would have occurred by delivering older agents to all eligible patients. Society's huge investment in technological innovations that only modestly improve effi cacy, by consuming resources needed for improved delivery of care, may cost more lives than it saves. The misalignment of priorities is driven partly by the commercial interests of industry and by the public's appetite for technological breakthroughs, but health outcomes ultimately suffer. Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care. INTRODUCTIONA lthough modern medicine can be proud of its successes in the prevention and treatment of disease, much more can be done to alleviate morbidity and premature mortality. Two transcendent problems predominate. First, available care is not delivered well: Americans do not always obtain the interventions that would improve their health or prevent illness. By one account, Americans receive only 55% of recommended health care services.1 Gaps in delivery are even greater for the poor and for racial and ethnic minorities.2 Second, the interventions that Americans do receive have limited effi cacy in improving outcomes. More lives could be saved by developing better drugs, technologies, and procedures. In effect, society faces a choice between these 2 strategies for bettering health and must strike a prudent balance in how many resources it allocates to each endeavor. FidelityThe fi rst endeavor addresses what might be described as the fi delity of health care. Independent of the effi cacy or effectiveness of interventions, fi delity is the extent to which the system provides patients the precise interventions they need, delivered properly, precisely when they need them. Fidelity is lacking when patients cannot make known their need for care (eg, there are barriers in access or communication), when clinicians cannot recognize that an intervention is indicated (eg, there is a lack of time, knowledge, attention, or memory), and when the intervention cannot be delivered properly (eg, there is inadequate infrastructure, procedures, safety, coordination, or information). Fidelity has less to do with the properties of interventions than with the functionality of the system that delivers them. It requires systems of care (eg, practice groups, hospitals) to have intelligent designs, skilled professionals, coordinated teams, adequate resources, compe...

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Office system interventions supporting primary care–based health behavior change counseling

Cited by 63 publications

References 43 publications

Effectiveness of Academic Detailing on Breast Cancer Screening among Primary Care Physicians in an Underserved Community

Effectiveness of Academic Detailing on Breast Cancer Screening among Primary Care Physicians in an Underserved Community

Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions, Behaviors, and Body Mass Index

The Break-Even Point: When Medical Advances Are Less Important Than Improving the Fidelity With Which They Are Delivered

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