Strategies designed to help primary care providers treat chronic diseases are also useful for targeting health risk behaviors such as smoking, alcohol abuse, poor diet and physical inactivity, according to a new study.

Medical practices with a flexible organizational culture and openness to new ideas are more likely to offer risk assessments, counseling and referral to community-based programs. However, the study also found that implementation of these approaches is rare across the country.

"Opportunities to address patients' health behaviors in strategic settings such as primary care practices often are missed," say study authors led by Dorothy Hung, Ph.D., of Columbia University.

The four behaviors included in the study are the nation's leading causes of death and disability, and the interventions are recommended by the U.S. Preventive Services Task Force. The review appears in the latest issue of The Milbank Quarterly.

Hung and colleagues focused on the Chronic Care Model (CCM), which was developed with support from the Robert Wood Johnson Foundation, which also provided funding and study data.

The study included 52 primary care practices, where staff completed cross-sectional surveys focusing on various elements of the CCM.

In particular, the study found that primary care practices are more likely to offer recommended preventive services if they:

-- are owned by a hospital health system
-- exhibit a culture of quality improvement
-- include a multispecialty physician staff and staff dieticians
-- use decision support in the form of point-of-care reminders and clinical staff meetings
-- employ clinical information systems such as electronic medical records

"Patients may benefit from more widespread implementation of the CCM adapted for prevention," the authors conclude.

"The strength of this study is that it talks about how you implement this into a busy practice where people are time-stretched and resource-stretched," said Ted Epperly, M.D., chair and program director of the Family Medicine Residency of Idaho. "It's not just a doctor-patient issue, it's a community issue."

"Many community resources are available for patients to receive additional, health-promoting care outside of the clinical setting," Hung said.

The Milbank Quarterly: Contact Heidi Bresnahan, publications manager, at (212) 355-8400

Hung DY, et al. Rethinking prevention in primary care: applying the Chronic Care Model to address health risk behaviors. The Milbank Quarterly 85(1), 2007.

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