An Electronic Linkage System for Health Behavior Counseling: Effect on Delivery of the 5A's
Background
A variety of factors limit the ability of clinicians to offer intensive counseling to patients with unhealthy behaviors, and few patients (2%–5%) are referred to the community counseling resources that do offer such assistance. A system that could increase referrals through an efficient collaborative partnership between community programs and clinicians could have major public health implications; such was the subject of this feasibility evaluation.
Methods
At nine primary care practices, an electronic linkage system (eLinkS) was instituted to promote health behavior counseling and to automate patient referrals to community counseling services. Patients were offered 9 months of free counseling for weight loss, smoking cessation, and problem drinking at a choice of venues: group counseling, telephone counseling, computer care, and usual care. The delivery of behavioral counseling, measured by the 5A's (ask, address, advise, assess, agree, arrange) and patients' reported experiences with eLinkS, was examined.
Results
For 5 weeks eLinkS was used, until high referral volumes depleted counseling funds. Of the 5679 patients visiting the practices, 71% had an unhealthy behavior. Of these patients, 10% were referred for intensive counseling from a community program, most often for weight loss. Counseling and referrals occurred regardless of visit type—wellness, acute, or chronic care. eLinkS was used more often for middle-aged adults and women and by more-experienced clinicians.
Conclusions
The intervention increased the rate at which patients were referred for intensive behavioral counseling compared to current practice norms. Given the evidence that intensive counseling is more effective in promoting behavior change, implementing eLinkS could have substantial public health benefits.
aDepartment of Family Medicine, Virginia Commonwealth University, Richmond, Virginia
bDepartments of Family Medicine, Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia
cDepartments of Biostatistics and Family Medicine, Virginia Commonwealth University, Richmond, Virginia
dDepartments of Internal Medicine and Family Medicine, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
eDepartments of Health Administration and Family Medicine, Virginia Commonwealth University, Richmond, Virginia
fFairfax Family Practice Residency, Fairfax, Virginia
gRiverside Family Practice Residency, Newport News, Virginia
hShenandoah Family Practice Residency, Front Royal, Virginia
Address correspondence and reprint requests to: Alex H. Krist, MD, MPH, P.O. Box 980251, Richmond VA 23298-0251
ABSTRACT