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Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients

Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients. 2005 National Conference on Tobacco or Health. Presenters. Helen Roemhild, MEd, CCRA Pamela Werb, MEd, CCRC, CCRA Maribel Cifuentes, RN Kevin Peterson, MD, MPH Tai Mendenhall, PhD, LMFT.

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Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients

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  1. Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients 2005 National Conference on Tobacco or Health

  2. Presenters Helen Roemhild, MEd, CCRA Pamela Werb, MEd, CCRC, CCRA Maribel Cifuentes, RN Kevin Peterson, MD, MPH Tai Mendenhall, PhD, LMFT

  3. Minnesota Physicians Motivating Health Improvement: The MINIT Study University of Minnesota Medical School Department of Family Medicine and Community Health

  4. Research Team • Kevin Peterson Principal Investigator • Sharon Allen Co-Investigator • Tai Mendenhall Co-Investigator • Helen Roemhild Technical Assistance • Pam Werb Technical Assistance • Mark Janowiec Computer Programmer • Richard Botehlo Consultant

  5. Background • Funded by the Robert Wood Johnson Prescription for Health Initiative • Utilized Minnesota Academy of Family Physicians Research Network (MAFPRN) for clinic recruitment

  6. Minnesota Academy of Family Physicians Research Network(MAFPRN)

  7. MINIT StudyClinic Sites & Local Investigators • Parkview Medical Clinic (New Prague) • Dan Berg, MD • Park Nicollet Clinic (Minnetonka) • Don Pine, MD • Soteria Family Health Center (Plymouth) • Ruth Bolton, MD • Phalen Village Clinic (St. Paul) • George Smith, MD • Fairview – Eden Center Clinic (Eden Prairie) • David Johnson, MD

  8. MINIT StudyClinic Sites & Local Investigators (con’t) • Family Practice Medical Center (Willmar) • Mary Amon, MD • Creekside Family Physicians (St. Louis Park) • Shannon Neale, MD • Payne Avenue Medical Clinic (St. Paul) • Sharon Allen, MD, Phd • CentraCare Clinic (Long Prairie) • Paul Van Gorp, MD • Starbuck Clinic (Starbuck) • Stacy Luetmer, MD

  9. MINIT Study Sites Minnesota

  10. Community Partners • Blue Cross Blue Shield of Minnesota • Hazelden Foundation • Park Nicollet Foundation • Be Active Minnesota • Minnesota Partnership for Action Against Tobacco • HealthPartners, Inc. • National Diabetes Education Program

  11. Objective The aim of this pilot study was to assess subject recruitment issues including: • Number screened vs. number enrolled • Subject intervention mode preference • Stages of change movement (as determined by a specific process measure tool at baseline, 30 and 180 days) • Subject engagement in intervention

  12. Study Goals • Determine the feasibility of a program to address unhealthy behaviors in primary care patients who are not currently considering behavior change • Target smoking, risky drinking, unhealthy eating (obesity), sedentary lifestyle

  13. Design • 10 Primary Care Clinics • 18 Patients per clinic • Recruited patients scheduled for periodic health exams or non-acute visits • Standardized screening tools • Electronic real time enrollment

  14. Screening Questions • Do you smoke 10 cigarettes or more per day? • Body Mass Index (BMI) ≥ 25 • Do you exercise three or more times, or get 180 minutes or more of moderate exercise (such as walking) per week? • 5 Shot questionnaire for risky drinking

  15. Consent and Study Process • Obtained consent • Provider delivered motivational message • Scored for readiness to change • Intervention selection • Self help study guide • Telephone intervention with motivational coach and self help study guide • Interactive computer intervention with motivational coach and online self help study guide

  16. Online Intake Survey

  17. Follow-up Survey

  18. Results: Demographics • Totaleligible for enrollment (n = 114) • Male 30% (n = 34) • Female 70% (n = 80) • Ethnicity Caucasian 73% (n = 83) Native American 2% (n = 03) African American 1% (n = 01) Non-responders 24% (n = 27) • Ages 18 – 29 6% (n = 5) 30 – 39 17% (n = 15) 40 – 49 25% (n = 22) 50 – 64 35% (n = 40) 65+ 11% (n = 10)

  19. Results: Study Enrollment Self Help Telephone Computer

  20. Results: Subject Recruitment and Intervention Preference Number of patients screened (n = 152) Number of patients enrolled (n = 120) Intervention Preference 39% Smoking 31% Poor Diet 31% Exercise 1% Risky Drinking

  21. Results: Study Attrition 30 Day Follow-up telephone (7%) self-help (19%) computer (45%) 180 Day Follow-up telephone (4%) self-help (18%) computer (41%)

  22. Results: Readiness to Change 30 Day follow-up Percent of subjects moving from precontemplative to contemplative or contemplative to planning stage 55% Smoking (n = 31) 83% Poor Diet (n = 20) 77% Exercise (n = 22)

  23. Results: Readiness to Change 180 Day Follow-up Percent of subjects changing from precontemplative to contemplative or contemplative to planning stage 100% Smoking (n = 42) 100% Poor Diet (n = 32) 100% Exercise (n = 35)

  24. Summary • Patient preference for intervention • Attrition • Screening protocol • Electronic real time enrollment

  25. Contact Information Kevin Peterson, MD MPH University of Minnesota Medical School Department of Family Medicine and Community Health 925 Delaware Street SE, Suite 220 Minneapolis, MN 55414 Email: peter223@umn.edu

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