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Research ArticleCross-Project Analyses

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

Maribel Cifuentes, Douglas H. Fernald, Larry A. Green, Linda J. Niebauer, Benjamin F. Crabtree, Kurt C. Stange and Susan B. Hassmiller
The Annals of Family Medicine July 2005, 3 (suppl 2) S4-S11; DOI: https://doi.org/10.1370/afm.378
Maribel Cifuentes
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Douglas H. Fernald
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Larry A. Green
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Linda J. Niebauer
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Benjamin F. Crabtree
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Kurt C. Stange
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Susan B. Hassmiller
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    Figure 1.

    Geographic distribution of Prescription for Health practice-based research networks.

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    Figure 2.

    Integration of health behavior change strategies in primary care.

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    Table 1.

    Characteristics of Prescription for Health Projects

    PBRNBehaviors AddressedTarget PopulationActivation PointToolsTechniques
    PBRN = practice-based research network; PDA = personal digital assistant (ie, handheld computers); 5 A’s = ask, advise, agree, assist, arrange; BMI = body mass index; UCSF = University of California at San Francisco.
    Alabama Practice Based Research Network (APBRN)Diet, tobaccoAdultClinicianPDA, health advisor/coach5 A’s, motivational interviewing, goal setting/action plan, community links, e-mail follow-up
    Clinicians Enhancing Child Health (CECH)Activity, diet, tobacco, drinkingAdolescent (12–18 years)Clinician, patientPDA, health advisor/coach, educational materials, patient assessment/screen5 A’s, motivational interviewing, goal setting/action plan, community links, e-mail follow-up, clinician training
    Colorado Research Network (CaReNet), High Plains Research Network (HPRN)Activity, dietAdultClinician, staff, patientPedometer, patient assessment/screen, activity/nutrition logs, prescription padClinician/staff modeling of behavior change, goal setting/action plan, telephone follow-up
    Dartmouth-Northern New England COOP ProjectActivity, diet, tobacco, drinkingAdultPatient, practice, health plan, communityWeb site, registry, patient assessment/screen, vital signs5 A’s, goal setting/action plan, community links, group visits, telephone follow-up, e-mail follow-up, motivational interviewing
    Great Lakes Research Into Practice Network (GRIN)Activity, diet, tobacco, drinkingAdultPractice, nurseconsultantPractice assessment, consultant5 A’s, practice consultation, goal setting/action plan
    Kentucky Ambulatory Network (KAN)Activity, tobaccoAdultPatientPrescription pad, health advisor/coach, activity/nutrition logs, educational materials, patient assessment/screenCommunity program, goal setting/action plan, telephone follow-up
    Midwest Nursing Centers Consortium Research Network (MNCCRN)Activity, dietAdultClinician, patientPedometer, nutrition/activity logs, health advisor/coach, patient assessment/screenGroup visits, goal setting/action plan, community links, telephone follow-up
    Minnesota Academy of Family Physicians Research Network (MAFPRN)Activity, diet, tobacco, drinkingAdultPatient, staffWeb site, health advisor/coach, educational materials, vital signs, patient assessment/screenMotivational interviewing, community links, telephone follow-up, e-mail follow-up, clinician training, external personnel
    New England Clinicians Forum (NECF)Tobacco, drinkingAdultClinician, staffHealth advisor/coach, educational materials, vital signs, patient assessment/screenBrief intervention, scheduled follow-up visit, clinician training
    Northwest Ohio Primary Care Research Network (NOPCRN)Activity, dietAdultClinician, patientPDA, pedometer, activity/nutrition logs, patient assessment/screenGoal setting/action plan, telephone follow-up, clinician training
    Pediatric PitNetActivity, dietChildren (8–12 years)Clinician, staff, parentBMI chart, health advisor/coach, vital signs, educational materials, activity/nutrition logs, patient assessment/screenMotivational interviewing, community links, goal setting/action plan, group visits, clinician training
    Pediatric Practice Research Group (PPRG)Activity, dietChildren (2–10 years)Practice, patient, parentPDA, wall chart, educational materials, vital signs, patient assessment/screen, practice assessmentPractice consultation, clinician training
    Penn State Ambulatory Research Network (PSARN)Activity, dietAdultStaff, patientHealth advisor/coach, registry, educational materials, patient assessment/screenMotivational interviewing, goal setting/action plan, community links, telephone follow-up, e-mail follow-up, external personnel
    Research Association of Practices (RAP)Activity, diet, tobacco, drinkingAdultClinician, staff, patientWeb site, prescription pad, educational materials, patient assessment/screen, practice assessmentMotivational interviewing, community links
    Virginia Ambulatory Care Outcomes Research Network (ACORN)Activity, diet, tobacco, drinkingAdultClinician, patientWeb site, patient assessment/screen, educational materialsCommunity links
    Virginia Practice Support and Research Network (VaPSRN)Diet, tobaccoAdult and adolescentClinicianPDA, vital signs, patient assessment/screen, practice assessmentMotivational interviewing
    UCSF/Stanford Collaborative Research Network (CRN)Activity, diet, tobaccoAdultClinicianPatient assessment/screenGoal setting/action plan, clinician training, external personnel
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    Table 2.

    Strategies Implemented by Prescription for Health Projects by Domain of the Chronic Care Model

    DomainImplementation Strategies
    PDA = personal digital assistant (ie, handheld computer).
    Community resourcesLocally based community health advisors
 Web-based directories of community resources
 Web links to relevant information or resources outside community (regional or national)
    Health care organizationPracticewide assessments
 Clinician assessments (attitudes, satisfaction, readiness to change)
 Evaluation of use of specific tools or techniques
 Negotiated support from insurers for project activities
    Self-management supportPatient-centered goal setting and action plans
 Motivational interviewing techniques
 Physical activity and dietary logs
 Community resource directories
 Local walking club
 Periodic follow-up from health change facilitators, educators, or advisors
 Telephone and e-mail follow-up and support
 Pedometers
 Tailored behavior change educational materials or information
    Delivery system designPatient questionnaires before visit and ongoing (Web-based)
 Staff role changes and education
 Health advisors, educators, coaches/health change facilitators
 Brief interventions
 Periodic health assessments (vital signs and others)
 Prescription pads for health behaviors
 Group visits
 Telephone and e-mail follow-up support
    Decision supportPatient-reported health behavior information (before, during, and between visits)
 Relevant preventive services guidelines
 Patient readiness-to-change assessments
 Streamlined evidence-based assessment and screening tools
 Tailored scripts and techniques
 Patient-tailored care recommendations
 Targeted evidence-based recommendations
 Electronic (Web, PDA) decision-support tools
    Clinical information systemsPatient registries
 Reminder systems (electronic, posters, assessments, patient-reported behavior indicators, other)
 Patient-completed screening tools
 Logs and behavioral questionnaires
 Expanded vital signs to include risky health behaviors
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The Annals of Family Medicine: 3 (suppl 2)
The Annals of Family Medicine
Vol. 3, Issue suppl 2
1 Jul 2005
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Prescription for Health: Changing Primary Care Practice to Foster Healthy Behaviors
Maribel Cifuentes, Douglas H. Fernald, Larry A. Green, Linda J. Niebauer, Benjamin F. Crabtree, Kurt C. Stange, Susan B. Hassmiller
The Annals of Family Medicine Jul 2005, 3 (suppl 2) S4-S11; DOI: 10.1370/afm.378

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Prescription for Health: Changing Primary Care Practice to Foster Healthy Behaviors
Maribel Cifuentes, Douglas H. Fernald, Larry A. Green, Linda J. Niebauer, Benjamin F. Crabtree, Kurt C. Stange, Susan B. Hassmiller
The Annals of Family Medicine Jul 2005, 3 (suppl 2) S4-S11; DOI: 10.1370/afm.378
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  • The Role of the Champion in Primary Care Change Efforts: From the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP)
  • Intraclass Correlation Coefficients Typical of Cluster-Randomized Studies: Estimates From the Robert Wood Johnson Prescription for Health Projects
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  • Measuring Primary Care Expenses
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More in this TOC Section

  • Implementing Health Behavior Change in Primary Care: Lessons From Prescription for Health
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Subjects

  • Domains of illness & health:
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  • Other topics:
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