Preventing Chronic Disease | Clinician-Targeted Intervention and Patient-Reported Counseling on Physical Activity - CDC

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Preventing Chronic Disease | Clinician-Targeted Intervention and Patient-Reported Counseling on Physical Activity - CDC

Clinician-Targeted Intervention and Patient-Reported Counseling on Physical Activity

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• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Jennifer K. Carroll, MD, MPH; Paul C. Winters, MS; Mechelle R. Sanders; Francesca Decker, MD, MPH; Thanh Ngo; Christopher N. Sciamanna, MD, MPH

Suggested citation for this article: Carroll JK, Winters PC, Sanders MR, Decker F, Ngo T, Sciamanna CN. Clinician-Targeted Intervention and Patient-Reported Counseling on Physical Activity. Prev Chronic Dis 2014;11:130302. DOI:http://dx.doi.org/10.5888/pcd11.130302.

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Abstract

Introduction

Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population.

Methods

Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre–post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians’ counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews.

Results

Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0–15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program.

Conclusion

A clinician training intervention showed mixed results for 5As physical activity counseling.

Author Information

Corresponding Author: Jennifer K. Carroll, MD, MPH, University of Rochester Medical Center, Department of Family Medicine, Family Medicine Research Programs, 1381 South Ave, Rochester, NY 14620. Telephone: 585-506-9484 x219. E-mail: Jennifer_carroll@urmc.rochester.edu.

Author Affiliations: Paul C. Winters, Mechelle R. Sanders, Francesca Decker, Thanh Ngo, University of Rochester, Rochester, New York; Christopher N. Sciamanna, Penn State College of Medicine, Hershey, Pennsylvania.

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References

1. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey NHANES 2012–2012. http://wwwn.cdc.gov/nchs/nhanes/search/nhanes09_10.aspx. Accessed January 14, 2014.
2. Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE. Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Prev Med 2000;18(1):46–53. CrossRef PubMed
3. National Association of Community Health Centers. Community health centers: the return on investments, fact sheet 2012. http://www.nachc.com/client/CHCs%20ROI%20final.pdf. Accessed January 14, 2014.
4. Pinto BM, Goldstein MG, Ashba J, Sciamanna CN, Jette A. Randomized controlled trial of physical activity counseling for older primary care patients. Am J Prev Med 2005;29(4):247–55. CrossRef PubMed
5. Ackermann RT, Deyo RA, LoGerfo JP. Prompting primary providers to increase community exercise referrals for older adults: a randomized trial. J Am Geriatr Soc 2005;53(2):283–9. CrossRef PubMed
6. Petrella RJ, Koval JJ, Cunningham DA, Paterson DH. Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. Am J Prev Med 2003;24(4):316–22. CrossRef PubMed
7. Jay M, Gillespie C, Schlair S, Sherman S, Kalet A. Physicians’ use of the 5As in counseling obese patients: is the quality of counseling associated with patients’ motivation and intention to lose weight? BMC Health Serv Res 2010;10:159. CrossRef PubMed
8. Jay M, Schlair S, Caldwell R, Kalet A, Sherman S, Gillespie C. From the patient’s perspective: the impact of training on resident physician’s obesity counseling. J Gen Intern Med 2010;25(5):415–22. CrossRef PubMed
9. Harrison RL, Mattson LK, Durbin DM, Fish AF, Bachman JA. Wellness in community living adults: the Weigh to Life program. Patient Educ Couns 2012;86(2):270–6. CrossRef PubMed
10. Pbert L, Druker S, DiFranza JR, Gorak D, Reed G, Magner R, et al. Effectiveness of a school nurse-delivered smoking-cessation intervention for adolescents. Pediatrics 2011;128(5):926–36. CrossRef PubMed
11. Unrod M, Smith M, Spring B, DePue J, Redd W, Winkel G. Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians. J Gen Intern Med 2007;22(4):478–84. CrossRef PubMed
12. Glynn TJ, Manley MW. How to help your patients stop smoking: a manual for physicians. NIH Publication 89-3064 ed. Bethesda (MD): National Cancer Institute; 1989.
13. Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002;22(4):267–84. CrossRef PubMed
14. Elford RW, MacMillan HL, Wathen CN, Canadian Task Force on Preventive Health Care. Counseling for risky health habits: A conceptual framework for primary care practitioners. Report No. 01–7. London (ON): Canadian Task Force; 2001.
15. Khan KM, Weiler R, Blair SN. Prescribing exercise in primary care. BMJ 2011;343:d4141. CrossRef PubMed
16. Swedish National Institute of Public Health. Physical activity in the prevention and treatment of disease 2011. www.fhi.se/PageFiles/10682/Physical-Activity-Prevention-Treatment-Disease-webb.pdf. Accessed January 14, 2014.
17. The Centers for Medicare and Medicaid Services (CMS). Decision memo for intensive behavioral therapy for obesity (CAG-00433N) 2011. http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253. Accessed January 14, 2014.
18. Carroll JK, Mohr DC, Spring B, Figueroa-Moseley C, Jean-Pierre P, Sprod LK, et al. What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings. Transl Behav Med 2011;1(2):234–51.CrossRef PubMed
19. Lin JS, O’Connor E, Whitlock EP, Beil TL. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2010;153(11):736–50. CrossRef PubMed
20. Carroll JK, Fiscella K, Epstein RM, Sanders MR, Williams GC. A 5A’s communication intervention to promote physical activity in underserved populations. BMC Health Serv Res 2012;12:374. CrossRef PubMed
21. Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Kravitz RL, et al. Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues. Soc Sci Med 2005;61(7):1516–28. CrossRef PubMed
22. Lewin SA, Skea ZC, Entwistle V, Zworenstein M, Dick J. Interventions for providers to promote a patient-centered approach in clinical consultations. Cochrane Database Syst Rev 2001(4):CD003267. PubMed
23. Epstein RM. Assessment in medical education. N Engl J Med 2007;356(4):387–96. CrossRef PubMed
24. Sciamanna CN, Goldstein MG, Marcus BH, Lawrence K, Pinto BM. Accuracy of recall of exercise counseling among primary care patients. Prev Med 2004;39(6):1063–7. CrossRef PubMed
25. Cohen J. Statistical power analysis for the behavioral sciences. New York (NY): Academic Press; 1977.
26. Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ 2012;344:e1389. CrossRef PubMed
27. Moyer VA. Behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157(5):367–71. PubMed
28. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282(15):1458–65. CrossRef PubMed
29. Rosenberg CN, Peele P, Keyser D, McAnallen S, Holder D. Results from a patient-centered medical home pilot at UPMC Health Plan hold lessons for broader adoption of the model. Health Aff (Millwood) 2012;31(11):2423–31. CrossRef PubMed
30. Nocon RS, Sharma R, Birnberg JM, Ngo-Metzger Q, Lee SM, Chin MH. Association between patient-centered medical home rating and operating cost at federally funded health centers. JAMA 2012;308(1):60–6. CrossRef PubMed
31. National Committee for quality Assurance. Patient-centered medical home (PCMH)2011. http://www.ncqa.org/Home/PatientCenteredMedicalHome2011.aspx. Accessed January 14, 2014.