title: Coordination of health behavior counseling in primary care.
abstract: OBJECTIVE
  We wanted to examine how coordinated care is implemented in primary care practices to address patients' health behavior change needs.
  
  
  METHODS
  Site visit notes, documents, interviews, and online implementation diaries were collected from July 2005 to September 2007 from practice-based research networks (PBRNs) participating in Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks (P4H). An iterative group process was used to conduct a cross-case comparative analysis of 9 interventions. Published patient outcomes reports from P4H interventions were referenced to provide information on intervention effectiveness.
  
  
  RESULTS
  In-practice health risk assessment (HRA) and brief counseling, coupled with referral and outreach to a valued and known counseling resource, emerged as the best way to consistently coordinate and encourage follow-through for health behavior counseling. Findings from published P4H outcomes suggest that this approach led to improvement in health behaviors. Automated prompts and decision support tools for HRA, brief counseling and referral, training in brief counseling strategies, and co-location of referral with outreach facilitated implementation. Interventions that attempted to minimize practice or clinician burden through telephone and Web-based counseling systems or by expanding the medical assistant role in coordination of health behavior counseling experienced difficulties in implementation and require more study to determine how to optimize integration in practices.
  
  
  CONCLUSIONS
  Easy-to-use system-level solutions that have point-of-delivery reminders and decision support facilitate coordination of health behavior counseling for primary care patients. Infrastructure is needed if broader integration of health behavior counseling is to be achieved in primary care.
authors.affiliation: Department of Family Medicine, Oregon Health & Sciences University, Portland, Oregon 97239, USA. cohendj@ohsu.edu
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.forename: Nicole F
authors.initials: NF
authors.lastname: Isaacson
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Clark
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Etz
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D037001:Directive Counseling; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation / Q000458:organization & administration*; D018570:Risk Assessment; D014481:United States