No abstract

Purpose: An action plan is an agreement between clinician and patient that the patient will make a specific behavior change. The goals of this study are to: determine whether it is feasible for patients to make action plans in the primary care visit; determine whether patients report carrying out their action plans; and describe the action plans patients choose.Methods: Forty-three clinicians in 8 primary care sites were recruited to hold action-plan discussions with patients. Research assistants contacted patients by telephone 3 weeks later to assess whether patients had conducted their action plans.Results: Eighty-three percent of enrolled patients (228) made an action plan during a primary care visit. Of the 79% who recalled making the action plan when interviewed by telephone 3 weeks later, 56% recalled the details of their action plan, and an additional 33% recalled the general nature of the action plan. At least 53% of patients making an action plan reported making a behavior change consistent with that action plan.Conclusions: Most patients reported making a behavior change based on an action plan, suggesting that action plans may be a useful strategy to encourage behavior change for patients seen in primary care. Assisting patients to improve health-related behaviors is an important responsibility of primary care clinicians.1 However, physicians in primary careseldom have time to engage in behavior-change counseling and may be unsure how to discuss behavior change with their patients. 2-4One strategy to encourage behavior change involves a collaborative process in which patients choose a goal and clinicians and patients negotiate a specific action plan to assist in the goal's attainment. For example, the goal may be to lose 10 pounds; an initial action plan may be to substitute water in place of sugar-containing sodas. Patients should have a high level of confidence that they can accomplish the action plan; success increases selfefficacy (a person's confidence that he/she can make positive life changes), and self-efficacy has been associated with healthier behaviors and improved clinical outcomes. 5Several studies suggest that collaborative goal setting and action planning may be more effective in promoting behavior change than traditional clinician-directed advice.6 -8 However, no study offers details on action plans as a specific behavior-change intervention in primary care.We performed a descriptive study of action plans in a diverse sample of primary care patients with coronary heart disease (CHD) risk factors. A companion article 9 discusses the acceptability and feasibility of primary care clinicians engaging their patients in action-plan discussions. In this article, we explore the following questions. 1) To what extent are patients able to make an action plan with their clinician during a routine primary care visit? 2) What types of action plans do patients and clinicians make? 3) What proportion of patients are able to describe, and report carrying out, their action plans after 3 weeks? 4) Are c...

Purpose: Collaborative goal-setting-with clinician and patient together deciding on concrete behaviorchange goals-may be more effective in encouraging healthy behaviors than traditional clinician-directed advice. This study explores whether it is feasible for clinicians to engage patients with coronary heart disease (CHD) risk factors in collaborative goal-setting and concrete action planning during the primary care visit.Methods: Primary care clinicians were trained in goal-setting and action planning techniques and asked to conduct action plan discussions with study patients during medical visits. Clinicians' experiences were documented through post-visit surveys and with questionnaires and semistructured interviews at the end of the study.Results: Forty-three clinicians and 274 patients with CHD risk factors participated in the study; 83% of the patient encounters resulted in a behavior-change action plan. Goal-setting discussions lasted an average of 6.9 minutes. Clinicians rated 75% of the discussions as equally or more satisfying than previous behavior-change discussions, and identified time constraints as the most important barrier to adopting the goal-setting process.Conclusions Coronary heart disease (CHD), the leading cause of mortality in the United States, is strongly associated with modifiable behaviors including physical inactivity, poor diet, and tobacco use.1 Seventyseven percent of the US adult population engages in a low level of physical activity, 58% are overweight, 23% use tobacco, 2 and 53% have more than one of these risk factors.3 However, physicians inconsistently provide health behavior-change advice to their patients. From 1992 to 2000, diet and physical activity counseling took place in fewer than 45% and 30%, respectively, of primary care visits by adults with CHD risk factors. 4 Physicians in primary care seldom have time to engage in such discussions and may be unsure how to discuss behavior change with their patients. 5-7The research presented here describes a method for engaging patients in behavior-change discussions within primary care: goal-setting with action planning. This process is based on the emerging collaborative model of patient care. 8 -10 In this paradigm, patients set a goal for a behavior they wish to change, and clinicians engage patients in a discussion of an action plan that can help the patient fulfill the goal. The action plan should be concrete and specific. With nonspecific action plans, eg, to exercise or lose weight, patients cannot evaluate their success and often experience failure. To enhance the likelihood that patients will succeed with their action plan, clinicians ask patients to estimate,

Automated methods of radiation dose data collection permit a detailed analysis of radiation dose according to protocol and equipment over time. Radiation dose optimization measures were effective, but their full value may be realized only with changes in internal processes and real-time, prospective data monitoring and analysis.