Bridging Primary Care Practices and Communities to Promote Healthy Behaviors

Etz, Rebecca; Cohen, Deborah J.; Woolf, Steven H.; Holtrop, Jodi Summers; Donahue, Katrina E; Isaacson, Nicole; Stange, Kurt C.; Ferrer, Robert L.; Olson, Ardis L.

doi:10.1016/j.amepre.2008.08.008

Cited by 103 publications

(121 citation statements)

References 13 publications

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“…The AAFP has published a policy statement regarding healthy eating in schools, 37 and one study has examined the ways in which linkages between primary care practices and community resources could be of benefit as well as lessen the burden on the US health care system; infrastructure support and communication systems were identified as crucial to creating and sustaining such linkages. 38 Limitations of our study included a possible response bias; physicians who had a stronger interest in childhood overweight may have been more likely to return the survey. Our survey was limited to practicing AAFP members and we had a relatively low response rate.…”

Section: Discussionmentioning

confidence: 99%

Screening and Counseling for Childhood Obesity: Results from a National Survey

Sesselberg

Klein²,

O’Connor³

et al. 2010

The Journal of the American Board of Family Medicine

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Purpose: To examine family physicians' beliefs and practices about using body mass index (BMI) percentiles to screen for childhood overweight and obesity.Methods: Surveys about management of childhood overweight were mailed to 1800 American Academy of Family Physician members in 2006.Results: 729 surveys were returned; 445 were eligible. Most (71%) members were familiar with BMI guidelines; 41% were familiar with American Academy of Family Physician recommendations about overweight. Most (78%) had tools available to calculate BMI; fewer have enough time for overweight screening (55%), and only 45% reported computing BMI percentile at most or every well visit for children older than 2. Having an electronic health record increased BMI screening rates. Family physicians felt prepared to discuss weight, but only 43% believed their counseling was effective and many (55%) lack community or referral services. Most (72%) wanted simple diet and exercise recommendations for patients. Reimbursement for weight-related services is insufficient: 86% say that patients cannot pay for services not covered by insurance. Factor analysis identified clinician self-efficacy, resources, and reimbursement as factors related to calculating BMI percentiles.

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Section: Discussionmentioning

confidence: 99%

Screening and Counseling for Childhood Obesity: Results from a National Survey

Sesselberg

Klein²,

O’Connor³

et al. 2010

The Journal of the American Board of Family Medicine

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“…Their reports helped illuminate how difficult real-world, practical trials can be. 21,29 Other Prescription for Health investigators noted that implementation of interventions were uneven and difficult in some networks. 30,31 Although the ability to implement an intervention is important to consider when evaluating the utility of an intervention in practices, it was not possible in this study to assess how implementation variance affected the outcomes or how to interpret positive findings.…”

Section: Methodsmentioning

confidence: 99%

Improving Multiple Health Risk Behaviors in Primary Care: Lessons from the Prescription for Health COmmon Measures, Better Outcomes (COMBO) Study

Fernald

Dickinson

Froshaug

et al. 2012

The Journal of the American Board of Family Medicine

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Background: Four health behaviors-smoking, risky drinking, physical inactivity, and unhealthy diets-contribute substantially to health care burden and are common among primary care patients. However, there is insufficient evidence to recommend broadly brief interventions to address all 4 of these in frontline primary care. This study took advantage of a multinetwork initiative to reflect on health behavior outcomes and the challenges of using a common set of measures to assess health behavior-change strategies for multiple health behaviors in routine primary care practice.Methods: Standardized, brief practical health behavior and quality of life measures used across 7 practice-based research networks (PBRNs) with independent primary care interventions in 54 primary care practices between August 2005 and December 2007 were analyzed. Mixed-effects longitudinal models assessed whether intervention patients improved diet, physical activity, smoking, alcohol consumption, and unhealthy days over time. Separate analyses were conducted for each intervention.Results: Of 4463 adults, 2199 had follow-up data, and all available data were used in longitudinal analyses. Adjusting for age, race/ethnicity, education, and baseline body mass index where available, diet scores improved significantly in 5 of 7 networks (P < .02). Physical activity improved significantly in 2 networks but declined in one network (P < .024). The likelihood of being a current smoker was reduced in 2 of 5 networks (P < .0001), and average alcoholic drinks per day was reduced in 2 network s (P < .02). Participants reported fewer unhealthy days at follow-up in 3 of 7 networks (P < .01). Details of implementation and the limitations in instrumentation help contextualize these modest outcomes.Conclusions: Although some patients in these 7 PBRNs improved in several health behaviors and quality of life, the strength of evidence for field-ready methods to address multiple health risk behaviors remains elusive. The use of common measures to assess changes in 4 unhealthy behaviors was achieved practically in PBRNs testing diverse strategies to improve behaviors; however, variations in implementation, instrumentation performance, and some features of study design overwhelmed potential cross-PBRN comparisons. For common measures to be useful for comparisons across practices or PBRNs, greater standardization of study designs and careful attention to practicable implementation strategies are necessary. (J Am Board Fam Med 2012;25:701-711.)

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“…The few studies that have investigated community linkages suggest that consistent involvement and familiarity with a patient's community contributes to better coordination of care, improved health behaviors, increased family centeredness, and efficient and effective use of resources [4][5][6]. The specific effects of these community linkages are often difficult to tease out as they are often studied in tandem with other aspects of the medical home.…”

Section: Introductionmentioning

confidence: 99%