Abstract
Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3–15.8 %, p < 0.001), set goals for six risks (range of differences 3.8–16.6 %, p < 0.01), and improve five risks (range of differences 5.4–13.6 %, p < 0.01). Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.
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Clinicaltrials.gov identifier: NCT01825746
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Acknowledgments
Funding for the MOHR project was provided by the National Cancer Institute, Agency for Healthcare Research and Quality, Office of Behavioral and Social Sciences Research, and National Center for Advancing Translational Sciences (CTSA Grant Number ULTR00058). The opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the funders.
We would like to thank the research teams for their valuable efforts including Melissa Hayes, Steve Mitchell, Mark Greenawald, Mark Kelly, Rodger Kessler, Jill Arklind, Joseph Carroll, Christine Nelson, John Heintzman, Maria Fernandez, Kayla Fair, Julie Ribardo, Dylan Roby, Jennifer Leeman, and Alexis Moore.
Most of all, we would like to thank our practices for their partnership, insights, and hard work: Vienna Primary and Preventive Medicine, Little Falls Family Practice, Charles City Regional Health Services, Chester Family MedCare, Carilion Family Medicine—Roanoke Salem, Carilion Family Medicine—Southeast, Berlin Family Health, Milton Family Practice, Humbolt Open Door Clinic, McKinleyville Community Health Center, St. Johns’ Well Child and Family Center, Spring Branch Community Health Center—Pitner Clinic, Spring Branch Community Health Center—Hillendahl Clinic, HealthPoint Community Health Centers—Navasota, HealthPoint Community Health Centers—Hearne, Murfeesboro Clinic, and Snow Hill Clinic
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The authors have adhered to ethical principles throughout this research study including writing and submitting this manuscript. Specifically, we adhered to the Committee on Publication Ethics (COPE) guidelines, seven institutional IRB protocols, and appropriate informed consent processes for research participants.
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Implications
Practice
Administering a patient-centered health risk assessment in primary care will identify a significant number of unhealthy behaviors and mental health needs allowing patients and clinicians to better set goals that will improve health.
Policy
Better integration of primary care with mental health and health behavior counselors is needed to address the modifiable risks that will be identified as health risk assessments are more commonly used in primary care.
Research
A greater understanding about how to routinely support the use of health risk assessments in primary care as well as how to deliver intensive counseling to patients ready to make changes is needed.
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Krist, A.H., Glasgow, R.E., Heurtin-Roberts, S. et al. The impact of behavioral and mental health risk assessments on goal setting in primary care. Behav. Med. Pract. Policy Res. 6, 212–219 (2016). https://doi.org/10.1007/s13142-015-0384-2
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DOI: https://doi.org/10.1007/s13142-015-0384-2