Communication about behavioral health risks

Makoul, Gregory; Dhurandhar, Anjali; Goel, Mph Mita Sanghavi; Scholtens, Denise M.; Rubin, Alan

doi:10.1111/j.1525-1497.2006.00467.x

Cited by 15 publications

(5 citation statements)

References 40 publications

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“…Also, we were unable to assess the extent to which behavioral health issues would be discussed during clinical encounters without the health assessment. Previous research, however, suggests that clinical discussions about behavioral health and mental health (Makoul et al 2006) occur much less frequently than the level of clinician-patient discussions reported by patients in the current study. Finally, a chart audit was not conducted to assess the concordance of self-reports and clinical data.…”

Section: Discussioncontrasting

confidence: 79%

Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment

Rodríguez

Glenn²,

Olmos

et al. 2014

The Journal of the American Board of Family Medicine

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Background Assessing patient-reported health behaviors is a critical first step to prioritizing prevention in primary care. We assessed the feasibility of point-of-care behavioral health assessment in nine diverse primary care practices, including four federally-qualified health centers (FQHCs), four Practice-based Research Network (PBRN) practices, and a Department of Veterans Affairs (VA) practice. Methods In this prospective mixed-methods study, practices were asked to integrate a standardized paper-based health behavior and mental health assessment into their workflow for 50 or more patients. We used three data sources to examine the implementation process: 1) patient responses to the health assessment, 2) patient feedback surveys about how assessments were used during encounters, and 3) post-implementation interviews. Results Most (71%) non-urgent patients visiting the participating practices during the implementation period completed the health assessment, but reach varied by practice (range: 59-88%). Unhealthy diet, sedentary lifestyle, and stress were the most common patient problems with similar frequencies observed across practices. The median number of “positive screens” per patient was similar across FQHCs (3.7-positives, SD=1.8), PBRN practices (3.8-positives, SD=1.9), and the VA clinic (4.1-positives, SD=2.0). Primary care clinicians discussed assessment results with patients about half of the time (54%), with considerable between practice variation (range: 13%-66% with lowest use among FQHC clinicians). Although clinicians were interested in routinely implementing assessments, many reported not feeling confident of having resources or support to address all patients’ behavioral health needs. Conclusions Primary care practices will need to revamp their patient-reported data collection processes in order to integrate routine health behavior assessments. Implementation support will be required if health assessments are to be actively used as part of routine primary care.

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Section: Discussioncontrasting

confidence: 79%

Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment

Rodríguez

Glenn²,

Olmos

et al. 2014

The Journal of the American Board of Family Medicine

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“…13–23 A number of federal agencies’ practice guidelines based on this evidence advise clinicians to either provide or refer patients to receive counseling in health behavior change. 17–19,24,25 Findings confirm modest but significant impacts of brief physician advice or intervention on smoking cessation, improved dietary quality, and increased physical activity.…”

Section: The Evidencementioning

confidence: 99%

“…13,18,19,22 The framework delineates 5 counseling steps that a provider can complete in several minutes: (1) Assess the risk behavior, (2) advise change, (3) agree on goals and an action plan via shared decision making, (4) assist with treatment, and (5) arrange follow-up. 37 A 5 A’s approach has been shown to produce significant changes in a variety of health behaviors, including smoking cessation, dietary change, and physical activity.…”

Section: Behavior Change Counseling In Practicementioning

confidence: 99%

“…37 A 5 A’s approach has been shown to produce significant changes in a variety of health behaviors, including smoking cessation, dietary change, and physical activity. 13,26,38–44 However, despite evidence of effectiveness and federal guidelines that recommend use of the 5 A’s, behavioral counseling is not delivered to patients consistently. 21,22 Limited visit time, competing medical priorities, and insufficient financial incentives for health promotion all create barriers.…”

Section: Behavior Change Counseling In Practicementioning

confidence: 99%

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Better Population Health Through Behavior Change in Adults

Spring¹,

Ockene²,

Gidding³

et al. 2013

Circulation

173

106

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“…These interviews may include provider checklists of topics addressed during the visit or counseling modules completed (e.g., (Aalto et al, 2002; Aira et al, 2003, 2004); direct observation of sessions (Seppa et al, 2004; Makoul et al, 2006; McCormick et al, 2006; Bertakis & Azari, 2007; Gaume et al, 2008; Allamani et al, 2009), or review of records (e.g., Aira, 2004). Such studies consistently demonstrate that providers do not routinely ask about alcohol (e.g., Aalto et al, 2002), and rarely do so using standardized questionnaires (Seppa et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Brief Intervention for Heavy Drinking in Primary Care

Rose

Guth

Badger

et al. 2015

Journal of Addiction Medicine

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BACKGROUND Alcohol brief intervention (BI) in primary care (PC) is effective, but remains underutilized in spite of multiple efforts to increase provider-initiated BI. An alternative approach to promote BI is to prompt patients to initiate alcohol-related discussions. Little is known about the role of patients in BI delivery. OBJECTIVE To determine the characteristics of PC patients who reported initiating BI with their providers, and to evaluate the association between initiator (patient vs. provider) and drinking following a BI. METHODS In the context of clinical trial, patients (N=267) who received BI during a PC visit reported on the manner in which the BI was initiated, readiness to change, demographics, and recent history of alcohol consumption. Drinking was assessed again at 6-months following the BI. RESULTS Fifty percent of patients receiving a BI reported initiating the discussion of drinking themselves. Compared with those who reported a provider-initiated discussion, self-initiators were significantly younger (43.7 vs. 47.1, p=.03), more likely to meet DSM criteria for current major depression (24% vs. 14%, p=.04), and more likely to report a history of alcohol withdrawal symptoms (68% vs. 52%, p<.01). Baseline readiness to change, baseline consumption rates, and current DSM-IV alcohol dependence were not different between groups. In the two-to-three weeks following BI, self-initiators reported greater decreases in drinks per week (5.7 vs. 2.4, p=.02), and drinking days per week (1.0 vs. 0.3, p=.002). At six month follow up, self-initiators showed significantly greater reductions in weekly drinking compared to those whose provider initiated the BI (p=.002). CONCLUSIONS Patient- and provider-initiated BI occurred with equal frequency, and patient-initiated BIs were associated with greater reductions in alcohol use. Future efforts to increase the BI rate in PC should include a focus on prompting patients to initiate alcohol-related discussions.

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Communication about behavioral health risks

Abstract: BACKGROUND: As behavioral health risks account for the major causes of preventable morbidity and mortality in the United States, national guidelines recommend that physicians routinely screen patients for risk factors, and counsel as appropriate.

Cited by 15 publications

References 40 publications

Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment

Real-World Implementation and Outcomes of Health Behavior and Mental Health Assessment

Better Population Health Through Behavior Change in Adults

Brief Intervention for Heavy Drinking in Primary Care

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