title: Prescription for health: changing primary care practice to foster healthy behaviors.
abstract: OBJECTIVE
  The leading causes of premature death in the United States are linked to 4 behaviors: smoking, unhealthy diet, physical inactivity, and risky alcohol use. We report lessons from 17 exploratory projects funded under Prescription for Health that tested the feasibility of innovative behavior change strategies for at least 2 of these behaviors in primary care practices.
  
  
  METHODS
  Seventeen practice-based research networks (PBRNs) implemented and evaluated tools, cues, and techniques in 120 family medicine, internal medicine, pediatric, and nursing practices across an ethnically diverse sample of adults, children, and adolescents in rural and urban settings. We reviewed progress reports and notes from site visits and 3 meetings to generate overarching lessons.
  
  
  RESULTS
  PBRNs successfully implemented their projects in diverse practices despite reported logistical challenges and practice constraints. The networks showed that distributing the effort across the care team and throughout the practice and community is possible. Although each behavior required specific attention, each did not require its own separate staff and system. Three models emerged as helpful guides for the comprehensive redesign of health behavior counseling, but they require adaptation for use in real-world primary care settings. Traditional methods of collaboration yielded mixed results, making obvious a need for dedicated collaboration funds and a better framework to identify and align high-yield opportunities.
  
  
  CONCLUSIONS
  These projects confirm the feasibility of health behavior counseling in primary care practice. They also highlight the need for substantive practice redesign, and the value of models and frameworks to guide redesign and collaborative efforts.
authors.affiliation: Prescription for Health National Program Office, Department of Family Medicine, University of Colorado Health Sciences Center, Aurora 80045-0508, USA. Maribel.Cifuentes@uchsc.edu
authors.forename: Maribel
authors.initials: M
authors.lastname: Cifuentes
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Fernald
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Niebauer
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.forename: Susan B
authors.initials: SB
authors.lastname: Hassmiller
mesh_terms: D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D011320:Primary Health Care / Q000592:standards*; D014481:United States