Engaging primary care patients to use a patient-centered personal health record.

Purpose: Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care.

Methods: We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices.

Clinical and community delivery systems for preventive care: an integration framework.

Although clinical preventive services (CPS)-screening tests, immunizations, health behavior counseling, and preventive medications-can save lives, Americans receive only half of recommended services. This "prevention gap," if closed, could substantially reduce morbidity and mortality. Opportunities to improve delivery of CPS exist in both clinical and community settings, but these activities are rarely coordinated across these settings, resulting in inefficiencies and attenuated benefits.

Interactive preventive health record to enhance delivery of recommended care: a randomized trial.

Purpose: Americans receive only one-half of recommended preventive services. Information technologies have been advocated to engage patients. We tested the effectiveness of an interactive preventive health record (IPHR) that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational resources, and generates reminders.

Designing a patient-centered personal health record to promote preventive care.

Background: Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential.

Methods: Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion.

The relative importance of patient-reported barriers to colorectal cancer screening.

Background: Colorectal cancer (CRC) screening rates are suboptimal. The most important barriers identified by patients are poorly understood. A comprehensive assessment of barriers to all recommended modalities is needed.

Promoting primary care smoking-cessation support with quitlines: the QuitLink Randomized Controlled Trial.

Background: Counseling by clinicians promotes smoking cessation, but in most U.S. primary care practices, it is difficult to provide more than brief advice to quit in the course of routine work.

Patient costs as a barrier to intensive health behavior counseling.

Background: Although intensive health behavior counseling has been demonstrated to help patients lose weight and quit smoking, many payers offer limited coverage for such counseling.

Purpose: This mixed-methods case study examined how coverage affected utilization of an electronic linkage system (eLinkS) to help adult patients obtain intensive health behavior counseling, provided through a collaboration of primary care practices and community programs.

Methods: Grant support enabled patients to obtain counseling at no cost, but funds were exhausted within 5 weeks as a result of an overwhelming response.

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.

Effect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study.

Purpose: Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation counseling.

Methods: This study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN).

A practice-sponsored Web site to help patients pursue healthy behaviors: an ACORN study.

Purpose: We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change.

Methods: In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians.

Putting it together: finding success in behavior change through integration of services.

Purpose: The purpose of this analysis and commentary was to explore the rationale for an integrated approach, within and outside the office, to help patients pursue healthy behaviors.

Methods: We examined the role of integration, building on (1) patterns observed in a limited qualitative evaluation of 17 Prescription for Health projects, (2) several national policy initiatives, and (3) selected research literature on behavior change.

Results: The interventions evaluated in Prescription for Health not only identified unhealthy behaviors and advised change, but also enabled patients to access information at home, use self-help methods, obtain intensive counseling, and receive follow-up.