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Prescription for Health: Changing Primary Care Practice to Foster Healthy Behaviors

¹ Prescription for Health National Program Office, Department of Family Medicine, University of Colorado Health Sciences Center, Aurora, Colo
² Department of Family Medicine, University of Medicine and Dentistry, Robert Wood Johnson Medical School, Somerset, NJ
³ Department of Family Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
⁴ The Robert Wood Johnson Foundation, Princeton, NJ

CORRESPONDING AUTHOR: Maribel Cifuentes, RN, BSN, Prescription for Health National Program Office, PO Box 6508, Mail Stop F-496, Aurora, CO 80045-0508, Maribel.Cifuentes{at}uchsc.edu

PURPOSE The leading causes of premature death in the United States are linked to 4 behaviors: smoking, unhealthy diet, physical inactivity, and risky alcohol use. We report lessons from 17 exploratory projects funded under Prescription for Health that tested the feasibility of innovative behavior change strategies for at least 2 of these behaviors in primary care practices.

METHODS Seventeen practice-based research networks (PBRNs) implemented and evaluated tools, cues, and techniques in 120 family medicine, internal medicine, pediatric, and nursing practices across an ethnically diverse sample of adults, children, and adolescents in rural and urban settings. We reviewed progress reports and notes from site visits and 3 meetings to generate overarching lessons.

RESULTS PBRNs successfully implemented their projects in diverse practices despite reported logistical challenges and practice constraints. The networks showed that distributing the effort across the care team and throughout the practice and community is possible. Although each behavior required specific attention, each did not require its own separate staff and system. Three models emerged as helpful guides for the comprehensive redesign of health behavior counseling, but they require adaptation for use in real-world primary care settings. Traditional methods of collaboration yielded mixed results, making obvious a need for dedicated collaboration funds and a better framework to identify and align high-yield opportunities.

CONCLUSIONS These projects confirm the feasibility of health behavior counseling in primary care practice. They also highlight the need for substantive practice redesign, and the value of models and frameworks to guide redesign and collaborative efforts.

Key Words: Health behavior change • counseling • health behavior • practice change • primary care redesign • practice-based research network • behavioral/psychosocial • health promotion/disease prevention

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