Report Finds Behavior Key to Patient Health

Behavior is estimated to have more impact on health than genetics, social circumstances, environment or health care, says family physician Larry A. Green, M.D., in the preface to a research report. "Indeed, the choices we make about using tobacco and alcohol, physical activity, and diet are powerful, changeable contributors to suffering needlessly and dying prematurely."

That's how Green launches a 68-page report on first-round results from Prescription for Health, a national program of the Robert Wood Johnson Foundation with support from the Agency for Healthcare Research and Quality. Green, senior scholar in residence at AAFP's Robert Graham Center in Washington and professor of family medicine at the University of Colorado, Denver, directs Prescription for Health from the program's Denver office.

The RWJ Foundation, AHRQ and the nation's practice-based research networks united in Prescription for Health, says Green, "to step up and make a difference. The basic idea is to move onto the largest single platform of health care delivery -- the offices of primary care clinicians -- to discover what it actually takes to help individuals make and sustain healthier choices."

The report presents lessons learned through 17 projects funded by Prescription for Health. For example, two practice-based research networks conducted a study of 12 primary care practices using Leaders in Effective Activity Planning, or LEAP, a process for counseling, goal-setting and feedback. The networks found that staff in the practices are improving their own physical activity, adopting healthy diets and enrolling patients in a study on patients' efforts to meet activity/eating goals.

In the six intervention practices (varying from the six control practices), staff had change coaches and used LEAP behavior change tools for a month before enrolling patients. Many practice members in the intervention group reported considerable lifestyle changes, including three previously "inactive" staff members who participated in a minitriathlon. In addition, patients in intervention practices reported data for more weeks than did patients in control practices.

Another project tested three models for screening and brief behavioral counseling about tobacco use and risky drinking in medically underserved populations. One model had a physician or physician assistant providing counseling, one model had a staff medical assistant or nurse doing counseling, and one model had an external assistant (not a staff member) performing the counseling. The seven participating practices were in federally qualified health centers.

The study investigators made these conclusions:

During the eight-month study period, the screening rate for the "clinician" (physician-PA) model was 18 percent of patients; the "specialist" (medical assistant-nurse) model screening rate was 25 percent, and the health educator model yielded a screening rate of 82 percent of patients.

The report, Prescription for Health: Changing Primary Care Practice to Foster Healthy Behaviors is a supplement to the July/August Annals of Family Medicine. In the preface, Green says projects in the second round of funding will push toward patient-oriented measures of health behaviors, compare effectiveness across research networks and "may identify achievable options for widespread dissemination."