Strategies designed to help primary care
providers treat chronic diseases are also useful for
targeting health risk behaviors such as smoking, alcohol
abuse, poor diet and physical inactivity, according
to a new study.
Medical practices with a flexible organizational culture
and openness to new ideas are more likely to offer risk
assessments, counseling and referral to community-based
programs. However, the study also found that implementation
of these approaches is rare across the country.
“Opportunities to address patients’ health
behaviors in strategic settings such as primary care
practices often are missed,” say study authors
led by Dorothy Hung, Ph.D., of Columbia University.
The four behaviors included in the study are the nation’s
leading causes of death and disability, and the interventions
are recommended by the U.S. Preventive Services Task
Force.
Hung and colleagues focused on the Chronic Care Model
(CCM), which was developed with support from the Robert
Wood Johnson Foundation, which also provided funding
and study data.
The study included 52 primary care practices, where
staff completed cross-sectional surveys focusing on
various elements of the CCM.
In particular, the study found that primary care practices
are more likely to offer recommended preventive services
if they:
- are owned by a hospital health system
- exhibit a culture of quality improvement
- include a multispecialty physician staff and staff
dieticians
- use decision support in the form of point-of-care
reminders and clinical staff meetings
- employ clinical information systems such as electronic
medical records
“Patients may benefit from more widespread implementation
of the CCM adapted for prevention,” the authors
conclude.
“The strength of this study is that it talks
about how you implement this into a busy practice where
people are time-stretched and resource-stretched,”
said Ted Epperly, M.D., chair and program director of
the Family Medicine Residency of Idaho. “It’s
not just a doctor-patient issue, it’s a community
issue.”
“Many community resources are available for patients
to receive additional, health-promoting care outside
of the clinical setting,” Hung said.
Hung DY, et al. Rethinking prevention in primary care:
applying the Chronic Care Model to address health risk
behaviors. The Milbank Quarterly 85(1), 2007.
