American Journal of Preventive Medicine
ArticleAn Electronic Linkage System for Health Behavior Counseling: Effect on Delivery of the 5A's
Section snippets
Background
Four unhealthy behaviors—tobacco use, unhealthy diet, physical inactivity, and risky alcohol use—account for approximately 37% of deaths in the U.S.1 Addressing these behaviors could help stem the rising prevalence and cost of chronic diseases,2, 3, 4 and clinicians can play a pivotal role. Americans have regular contact with clinicians and value their advice. A clinician's recommendation to change behavior is widely cited as a motivating factor.5, 6 Guidelines recommend that clinicians use the
Setting
Nine primary care practices in the Tidewater region of Virginia were recruited.25 The practices, members of a single medical group and of the Virginia Ambulatory Care Outcomes Research Network (ACORN), share a common type of EMR (GE Centricity Physician Office©) that is managed by a central informatics staff. The practices have used the EMR for 3 to 10 years. Practice size ranged from 1 to 30 clinicians (median=3), and 48 (87%) clinicians participated in the study. Two sites were solo
Study Population
A total of 5679 adult patients visited the practices during the 5-week exposure period. Their ages (median=53 years); gender (64% female); and frequency of prevention visits (14%) were typical of adult primary care populations (Table 2).33 The frequency of chronic-care visits at other places was lower than published norms (9% vs 44%)33 because only visits for selected reasons met this study's definition of relevant chronic illnesses. The prevalence of circulatory diseases was similar to the
Discussion
This study was designed to observe whether clinicians would use eLinkS, what options the patients would self-select, and what effect the intervention would have on counseling practices and patients' behaviors. The results are encouraging. The prompts appeared at more than one third of the encounters (due to the prevalence of overweight/obesity). The use of eLinks was steady throughout its 5 weeks of availability, and occurred at all manner of office visits, not just those devoted to prevention.
Conclusion
Collaboration between clinicians and community resources, as occurred here, presents a win–win scenario for patients, clinicians, and community programs. Patients obtain more-intensive assistance. Clinicians, who frequently cannot provide intensive counseling themselves,63 welcome an easy means to connect patients with the help they need. Community programs, which often struggle to attract clients through media and advertising, appreciate the influx of referrals from the medical community.
This
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2021, American Journal of Preventive MedicineCare provision to prevent chronic disease by community mental health clinicians
2014, American Journal of Preventive MedicineCitation Excerpt :Such telephone helplines have been demonstrated to be effective for the general population,64–68 and for people with a mental illness with regard to quitting smoking.69–72 Strategies found to be successful in increasing clinician provision of referrals to such services in general healthcare settings have included financial incentives,73 performance feedback,73–75 clinician training,75 electronic prompts,76 and electronic referral processes.76 However, no research has examined whether these findings extend to increasing referrals by mental health clinicians.
A qualitative inquiry about weight counseling practices in community health centers
2014, Patient Education and CounselingCitation Excerpt :Effective weight management and physical activity counseling should be incentivized as important quality measures for a PCMH. Third, findings suggest that community-clinic linkages have not been created consistently in CHCs; public health efforts should focus on working with communities and clinics to create easy access (both for patients and for clinicians) to evidence-based referral resources [16], and on identifying appropriate incentives to motivate patients to use identified resources. Finally, electronic health records could also be leveraged to provide clinicians with decision support prompts, facilitating more evidence-based interactions in the clinic.