Article Figures & Data
Tables
Health Risk Factor Question(s)3,7 Level of Concern/Risk None
“Healthy”Some
“At risk”High
“At risk”BMI22 Indicate height and weight 20–25 25 to <30 ≥30 Fast food intake Number of fast food meals or snacks over past 7 days <1 1 to 3 ≥4 Fruit and vegetable intake Servings of fruits/vegetables eaten per day over past 7 days ≥5 3 to 4 ≤2 Sugary beverage intake Number of soda and sugar sweetened drink per day over past 7 days <1 1 to 2 ≥3 Physical activity23 Number of days of exercise in past 7 days and average number of minutes of exercise per session ≥150 <150 <150 Stress How much stress experienced in past 7 days (0 to 10) 0–4 ≥5 ≥5 Anxiety or worry20 Over past 2 weeks summed frequency of: (1) feeling nervous, anxious or on edge (0 to 3) and (2) not being able to stop or control worrying (0 to 3) Score <4 Score ≥4a Score ≥4a Depression18,19 Over past 2 weeks summed frequency of: (1) feeling down, depressed or hopeless (0 to 3) and (2) little interest or pleasure in doing things (0 to 3) Score <4 Score ≥4a Score ≥4a Sleep Daytime sleepiness in past 7 days Rarely/never Often Always Tobacco use24 Used tobacco (smoking or smokeless) in last 30 days No use Used Used Alcohol intake25 Number of times in past year have had 4–5 or more drinks in a dayb Never 1 to 3×/yeara ≥4×/yeara Illegal drug use and prescription drug abuse Number of times in past year have used illegal drug or prescription medication for non-medical reasons None Used/misuseda Used/misuseda General health rating General rating of overall health Good, VeryGood, Excellent Fair Poor -
↵a Follow-up questions were asked, including the Generalized Anxiety Disorder 7-Item Scale20 (GAD-7; for anxiety or worry), Patient Health Questionnaire-918,19 (PHQ-9; for depression), the Alcohol Use Disorders Identification Test21 (AUDIT-C; for alcohol intake); Drug Abuse Screening Test17 (DAST-10; for drug use/misuse).
-
↵b Recommendation varies by gender: 4 applies to women and 5 applies to men.
-
Patient Characteristic No. (%) Total Risk Factors P Valuea Adjusted P Valuea,b Mean Median SD Min Max Sex .81 .82 Male 568 (33.27) 5.8 6 2.23 0 13 Female 1,138 (66.67) 5.8 6 2.07 0 12 Missing 1 (0.06) – – – – – Age <.001 <.001 <30c 212 (12.4) 5.9 6 2.09 1 12 30 to <50 582 (34.1) 6.1 6 2.12 0 13 50 to 70 787 (46.1) 5.7 6 2.08 0 12 ≥70 126 (7.4) 4.7 5 2.04 0 9 Race .02 .72 Whitec 1,219 (71.4) 5.7 6 2.15 0 13 Black or African American 380 (22.3) 6.1 6 1.93 1 11 Asian or Pacific Islander 24 (1.4) 5.8 5 2.35 2 12 Other 42 (2.5) 6.3 6.5 2.22 1 11 Missing 42 (2.5) 4.6 4.5 2.27 1 10 Ethnicity .01 <.001 Non-Hispanicc 1,150 (67.4) 5.9 6 2.14 0 13 Hispanic 487 (28.5) 5.6 5 2.02 0 12 Missing 70 (4.1) 5.5 5 2.35 1 11 Marital status <.001 .002 Single, never been marriedc 337 (19.7) 6.0 6 2.10 1 12 Married/living as married 892 (52.3) 5.5 5 2.11 0 12 Divorced/separated/widowed 452 (26.5) 6.2 6 2.02 1 13 Missing 26 (1.5) 6.0 6 2.91 1 10 Education <.001 <.001 <High schoolc 453 (26.5) 6.2 6 2.00 1 12 High school or equivalent 508 (29.8) 6.2 6 2.06 0 12 Some college, associate, or technical training 413 (24.2) 5.9 6 2.07 0 13 ≥College degree 306 (17.9) 4.6 4 1.99 0 11 Missing 27 (1.6) 5.7 6 2.71 1 10 Employment status <.001 <.001 Unemployedc 226 (13.2) 6.5 6 2.20 1 13 Disabled 265 (15.5) 6.7 7 1.95 1 11 Employed part-time 211 (12.4) 5.8 6 2.06 0 12 Employed full-time 518 (30.4) 5.6 5 2.03 0 12 Homemaker 181 (10.6) 5.4 6 2.00 0 11 Other/student 79 (4.6) 5.2 5 2.07 1 10 Retired 199 (11.7) 4.8 5 1.89 0 9 Missing 28 (1.6) 6.3 6.5 2.81 1 11 How well the patient speaks English .05 .26 Wellc 95 (5.6) 6.3 6 2.24 1 12 Very well 1,142 (66.9) 5.9 6 2.13 0 13 Not well/Not well at all 241 (14.1) 5.6 6 1.81 0 11 Missing 229 (13.4) 5.5 5 2.28 0 11 -
Note: Bold face indicates that the value is significantly different from that of the reference group (P <.05).
-
↵a P values are calculated using statistical analysis that excludes the Missing category of each demographic variable.
-
↵b P value adjusted to control for all other demographic factors.
-
↵c Reference value.
-
US Prevalence, % All Sites Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9 P Value Adjusted P Valuea Respondents, No. 1,707 114 130 291 141 113 271 214 246 187 Risk factors per patient, Mean (SD) 5.8 (2.1) 4.3 (2.0) 6.9 (1.9) 6.6 (2.0) 5.3 (2.3) 4.2 (1.9) 6.1 (1.8) 5.9 (2.0) 6.0 (2.0) 5.4 (2.1) <.001 Patients “at risk” for given risk factors, No. (%) Health behavior risk factors Fast food – 975 (57.1) 49 (43.0) 112 (86.2) 175 (60.1) 63 (44.7) 45 (39.8) 191 (70.5) 122 (57.0) 141 (57.3) 77 (41.2) <.001 <.001 Fruits and vegetables 76.526 1,443 (84.5) 88 (77.2) 120 (92.3) 241 (82.8) 117 (83.0) 88 (77.9) 250 (92.3) 180 (84.1) 199 (80.9) 160 (85.6) <.001 .003 Sugary beverages 23.927 763 (44.7) 17 (14.9) 110 (84.6) 164 (56.4) 30 (21.3) 14 (12.4) 148 (54.6) 96 (44.9) 131 (53.3) 53 (28.3) <.001 <.001 Physical activity 48.828 1,209 (70.8) 73 (64.0) 89 (68.5) 215 (73.4) 101 (71.6) 71 (62.8) 206 (76.0) 144 (67.3) 179 (72.8) 131 (70.1) .11 .34 Sleep – 1,091 (63.9) 62 (54.4) 90 (69.2) 199 (68.4) 96 (68.1) 72 (63.7) 190 (70.1) 131 (61.2) 159 (64.6) 92 (49.2) <.001 0.01 Alcohol intake 16.929 407 (23.8) 36 (31.6) 45 (34.6) 52 (17.9) 30 (21.3) 22 (19.5) 62 (22.3) 62 (29.0) 63 (25.6) 35 (18.7) .001 .008 Tobacco use 18.129 407 (23.8) 9 (7.9) 45 (34.6) 126 (43.3) 22 (15.6) 7 (6.2) 68 (25.1) 27 (12.6) 70 (28.5) 33 (17.7) <.001 .002 Illegal drug use or prescription drug abuse 9.230 55 (3.2) 2 (1.8) 8 (6.2) 18 (6.2) 5 (3.4) 1 (0.9) 2 (0.7) 6 (2.8) 7 (2.9) 6 (3.2) .03 .25 Psychosocial risk factors Anxiety or worry 18.131 265 (15.5) 13 (11.4) 31 (23.9) 79 (27.2) 24 (17.0) 9 (8.0) 20 (7.4) 29 (13.6) 26 (10.6) 34 (18.2) <.001 <.001 Depression 9.132 146 (8.9) 4 (3.5) 21 (16.2) 46 (15.8) 13 (9.2) 3 (2.7) 4 (1.5) 20 (9.4) 16 (6.5) 19 (10.2) <.001 <.001 Stress – 1,017 (59.6) 58 (50.9) 85 (65.4) 197 (67.7) 76 (53.9) 47 (41.6) 165 (60.9) 137 (64.0) 133 (54.1) 119 (63.6) <.001 .080 General health risk factors Body mass index 63.929 1,358 (79.6) 64 (56.1) 97 (74.6) 231 (79.4) 107 (75.9) 80 (70.8) 242 (89.3) 176 (82.2) 216 (87.8) 145 (77.5) <.001 <.001 Overall health status 17.129 767 (44.9) 19 (16.7) 42 (32.3) 162 (55.7) 56 (39.7) 13 (11.5) 94 (34.7) 136 (63.6) 147 (59.8) 98 (52.4) <.001 <.001 -
Note: All frequency values reported are the raw, unadjusted values.
-
↵a P value adjusted for age, sex, ethnicity, marital status, education, and employment status.
-
- Table 4
Readiness to Change, Desire to Discuss with Provider, and Importance Rating for Each Risk Factor
Health Risk Factors Respondents at Risk, No. Ready to Change, No. (%)a Desire to Discuss With Provider, No. (%)a Rated Most Important of Factors Ready to Change, No. (%)b Health behavior risk factors Any dietary factor 1,456 405 (27.8) 161 (11.1) 100/405 (24.7) Fast food 862 190 (22.0) 73 (8.5) 17/90 (9.0) Fruits and vegetables 1321 361 (27.3) 139 (10.5) 73/361 (20.2) Sugary beverages 652 120 (18.4) 48 (7.4) 10/120 (8.3) Physical activity 1,118 300 (26.8) 145 (13.0) 86/300 (28.7) Sleep 699 86 (8.6) 96 (9.6) 14/86 (16.3) Alcohol intake 362 71 (19.6) 37 (10.2) 5/71 (7.0) Tobacco use 361 68 (18.8) 49 (13.4) 21/68 (30.9) Illegal drug use or prescription drug abuse 45 10 (22.2) 9 (20) 2/10 (20.0) Psychosocial risk factors Anxiety or worry 232 53 (22.8) 82 (35.3) 19/53 (35.9) Depression 124 38 (30.7) 52 (41.9) 10/38 (26.3) Stress 930 209 (22.5) 210 (22.6) 65/209 (31.1) General health risk factors Body mass index 1,260 420 (33.3) 295 (23.4) 242/420 (57.6) Overall health status 723 172 (23.8) 125 (17.3) 114/172 (66.3) -
↵a The denominator for each health factor is the individuals classified as “at risk” for the factor who responded to the Ready to Change or Desire to Discuss with Provider questions (n=1,575).
-
↵b The denominator for each health factor is the individuals classified as “at risk” for the factor who were said they were ready to change their risk for the factor; ie, the number given in the Ready to Change column.
-
Additional Files
In Brief
Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment
Siobhan M. Phillips , and colleagues
Background Because behavioral factors help determine health, it is important to assess patient-reported health behaviors and psychosocial well-being. The My Own Health Report (MOHR) is a new electronic or paper-based health behavior and mental health risk assessment and feedback system. In preparation for integrating the MOHR into practice, this study examined the frequency of patient risk factors, the average number of risk factors per patient, and patients' perceptions of importance, readiness to change and desire to discuss identified risks with clinicians.
What This Study Found Patients reported a consistently high number of health risks, with more than one-half of patients reporting six or more risk factors. Despite the high number of health risks, most patients were not ready to change any risk factors and few wanted to discuss risk factors with their clinicians. The most common risk was poor diet (low fruit and vegetable consumption, frequent fast food consumption or frequent sugary beverage consumption), followed by overweight/obesity. Patients were most ready to change body mass index and depression and most wanted to discuss depression and anxiety or worry.
Implications
- These findings present a challenge, given the small amount of time available for prevention in primary care, and support the need for more integrated care.
- The authors suggest the need for routine administration of health risk assessments in primary care, the importance of real world approaches for implementing their findings and connecting patients and practices to appropriate resources, and the potential added value of including patients' perspective in the allocation of these resources.
Annals Journal Club
Nov/Dec: Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Discussion: Submit a comment.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
- Phillips SM, Glasgow RE, Bello G, et al. Frequency and prioritization of patient health risks from a structured health risk assessment. Ann Fam Med. 2014;12(6):505-513.
Discussion Tips
This paper presents useful information on (a) patient priorities in addressing their health behaviors and (b) the frequency of health risks in primary care. Do the data make a compelling case in support of an integrated care approach?
Discussion Questions
- What question is asked by this study and why does it matter?
- How does this study advance beyond previous research and clinical practice on this topic?
- How strong is the study design for answering the question?
- To what degree can the findings be accounted for by:
- How patients were selected or how many chose to participate?
- How the main variables were measured?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
- Chance?
- How the findings were interpreted?
- What are the main study findings?
- How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?
- What contextual factors are important for interpreting the findings?
- How might this study change your practice? In particular, will the study inform your approach to helping patients identify and address specific health risks?
- How might this study change policy? Education? Research?
- Who the constituencies are for the findings, and how might they be engaged in interpreting or using the findings?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197 http://annfammed.org/content/4/3/196.full.