BEHAVIORAL HEALTH
Improving Patient Outcomes Tools for promoting healthy behavior STEPHANIE A. HOOKER, PHD, MPH, MICHELLE D. SHERMAN, PHD, ABPP AND ANDREW H. SLATTENGREN, DO, FAAFP
E
vidence suggests that approximately 40% of the variance in health outcomes can be attributed to modifiable health behaviors, such as physical activity, dietary habits, smoking, alcohol use, and insufficient sleep. One of the ways to improve health outcomes is to address these modifiable risks and encourage patients to engage in healthier behaviors. Primary care is an ideal setting in which to address health behaviors. Many of the top reasons patients are seen in primary care have contributing behavioral components, including hypertension, chronic pain, and diabetes. Further, primary care offers easy access to care, continuity across time and stages of health and illness, and a comprehensive approach to health, which can enhance the development of trusting, collaborative relationships between clinicians and patients. Moreover, patients whose primary care clinicians ask about health behaviors (e.g., smoking) are more satisfied with their healthcare than patients whose clinicians do not. Thus, primary care clinicians need to be able to effectively discuss behavioral risks and encourage patients to make behavioral changes.
Several brief behavioral interventions have been found to be effective in primary care settings. For example, when primary care providers help patients set small, realistic goals for engaging in physical activity, patients increase their activity levels. However, despite many practice recommendations urging clinicians to address health behaviors with patients, primary care clinicians spend, on average, less than 1% of their time doing so. This discrepancy is likely due to many factors, including perceived insufficient time and low levels of confidence in delivering effective interventions. Perhaps further contributing to these problems is that little time is devoted to training physicians in medical school or residency on how to effectively encourage behavior change and to integrate these skills within their practices. Thus, there is a significant need for comprehensive curricula to train clinicians to use brief, behavioral interventions to address modifiable health risks.
Change that Matters: Promoting Healthy Behaviors To address the gap in comprehensive curricula, our multidisciplinary team at the University of Minnesota’s North Memorial Family Medicine Residency program and Broadway Family Medicine clinic created Change that Matters: Promoting Healthy Behaviors, a 10-module curriculum. This program teaches primary care clinicians brief, evidence-based interventions for common behavioral health topics, including alcohol use, chronic pain, depression, healthy eating, medication adherence, physical activity, sleep, social isolation, and stress. The development of the curriculum was co-led by two psychologists (Dr. Hooker and Dr. Sherman), and included input from professionals from multiple disciplines, including family medicine (faculty and residents), public health, nutrition, and pharmacy. Each module includes three components: • Didactic training, including slides that outline the importance of the behavior, assessment questions, evidence-based interventions, and practice of key skills • Electronic health record templates, including a documentation template to guide clinicians through how to deliver the intervention (assessment and goal-setting guide) and an after visit summary • Interactive patient handouts, available in English and Spanish, that guide the clinician and patient through a discussion about the topic, encourage goal setting, and problem solve potential barriers A key theme that runs through all modules is the idea that patients are encouraged to draw upon their values and sense of meaning in life to find motivation to make changes. Research suggests that when patients connect their reasons to change to the deeper “why” (e.g., to be able to spend more quality time with family), they are more likely to maintain those changes. The entire curriculum is available for free to download from the website, https://changethatmatters.umn.edu. On the website, there is also a detailed Implementation Guide and printable posters for exam rooms.
14
OCTOBER 2020 MINNESOTA PHYSICIAN
