Activity Counseling In Primary Care Research Articles

Insights From an Usability Review of an Electronic Medical Record–Integrated Physical Activity Counseling Tool for Primary Care

This study assessed primary care providers’ (PCPs) perceptions of the usability of an electronic medical record tool to support physical activity counseling in primary care. Our analyses revealed that usability improved when the electronic medical record tool followed a PCP’s natural workflow and when the tool could assist in engaging in a discussion about physical activity. Poor usability was associated with the presence of large amounts of text on the screen and technological aspects that required additional learning. Overall, efficiency, workflow integration, and the inclusion of a care plan were vital in a physical activity counseling tool for a primary care setting.

A patient-oriented approach to the development of a primary care physical activity screen for embedding into electronic medical records.

Physical activity questionnaires exist, but effective implementation in primary care remains an issue. We sought to develop a physical activity screen (PAS) for electronic medical record (EMR) integration by 1) identifying healthcare professionals' (HCPs), patients' and stakeholders' barriers to and preferences for physical activity counselling in primary care; and 2) using the information to co-create the PAS. We conducted semi-structured interviews with primary care HCPs, patients and stakeholders, and used content and thematic analyses to inform iterative co-design of the PAS. Interviews with 38 participants (mean age 41 years) resulted in 2 themes: 1) HCPs are willing to conduct physical activity screening, but acknowledge they don't do it well; and 2) HCPs have limited opportunity and capacity to discuss physical activity, and need a streamlined process for EMR that goes beyond quantifying physical activity. HCPs, patients and stakeholders co-designed a physical activity screen for integration into the EMR that can be tested for feasibility and effects on HCP behaviour and patients' physical activity levels. Novelty: EMR-integration of physical activity screening needs to go beyond just asking about physical activity minutes. Primary care professionals have variable knowledge and time, and need physical activity counselling prompts and resources. We co-developed a physical activity EMR tool with patients and primary care providers.

Physical Activity Counseling in Primary Care in Germany-An Integrative Review.

Physical activity counseling in primary health care is regarded as a useful complementary preventive and therapeutic measure and is advocated by leading public health institutions. This integrative review summarizes the available data on physical activity counseling in primary care in Germany. A systematic literature search in various databases (peer reviewed and grey literature) was carried out for quantitative and qualitative studies on physical activity counseling and use of “Exercise on Prescription”. The 25 studies included show a very high methodological diversity and, in some cases, considerable risks of bias, with limited comparability across studies. Counseling was provided in all studies by physicians. They report frequent physical activity counseling, which is partly confirmed and partly refuted by patient data. The use of “Exercise on Prescription” is at a very low level. Information on the frequency of physical activity counseling in Germany varies depending on data source and is sometimes contradictory. Our review provides a synthesis of various perspectives on routine physical activity counseling in primary care in Germany. Future studies using standardized and validated instruments in representative samples are needed to further knowledge on counseling and to be able to establish trends in prevalence. Strengthening the topics of physical activity and health and physical activity counseling in medical curriculum is strongly recommended.

Overview of Physical Activity Counseling in Primary Care

Physical inactivity is a global health burden. Promoting physical activity in primary care through physical activity counseling is an effective intervention. This article provides an overview of and perspectives on physical activity counseling in primary care. The identification of physical inactivity as a health problem may increase the awareness of physical inactivity among patients and primary care providers, which will lead to an action plan. The contents of physical activity counseling should be based on evidence-based recommendations. Safety issues should be evaluated appropriately to optimize the utilization of primary care services. Physical activity counseling methods should be “tailored” for an individual using appropriate counseling methods and setting-specific resources. Multilevel barriers to physical activity counseling in primary care (i.e., healthcare providers, patients, and systems) must be addressed. Setting-specific strategies to overcome these barriers should be implemented to maximize the effectiveness of physical activity counseling in primary care.

Promoting Physical Activity in a Primary Care Practice: Overcoming the Barriers

Along with proper diet and avoidance of tobacco use, physical activity is extremely important to maintain and improve overall health of the individual and population. Despite evidence for the cost-effectiveness of physical activity counseling in primary care, only one-third of patients report that they received physical activity counseling by their primary care physician (PCP). Both PCPs and patients face numerous barriers to addressing insufficient physical activity. To assist patients in overcoming their barriers to regular physical activity, the PCP should assess and address the patient's specific barriers to physical activity and counsel patients about the most common general barriers, such as lack of time, knowledge, and motivation. Numerous benefits and barriers are present, and the PCP should understand them and use the information to better counsel patients regarding the benefit of and need for regular physical activity. Brief counseling is an efficient, effective, and cost-effective means to increase physical activity and to bring considerable clinical benefits to various patient populations.

Physical activity counseling in primary care and family medicine residency training: a systematic review

BackgroundPhysical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs.MethodsThe authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review.ResultsBased on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling.ConclusionsThis systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.

First-Year Osteopathic Medical Students' Knowledge of and Attitudes Toward Physical Activity.

Current guidelines recommend that primary care physicians provide physical activity counseling as part of routine preventive health care. However, education regarding physical activity counseling often is not included or is inadequately covered in medical school curriculum, and it is unclear whether future physicians are prepared to offer effective counseling in this area. To examine first-year medical students' knowledge of and attitudes toward physical activity and the importance of physical activity in patient counseling. An anonymous electronic survey was distributed to all first-year students enrolled at the Ohio University Heritage College of Osteopathic Medicine. The survey assessed students' knowledge, beliefs, and behavior regarding physical activity and physical activity counseling for patients. The frequencies of students' weekly physical activity were computed to assess students' physical activity behaviors. Attitudes toward personal importance of physical activity and physical activity counseling in primary care were also assessed by response frequency. The relationship between students' knowledge of and participation in physical activity and the priority placed on exercise for future patients were assessed by correlation. Of 243 potential participants, 144 students (59.3%) returned the survey. The majority of students (131 of 144 [91.0%]) indicated that living a healthy lifestyle was very or extremely important to them, and 125 of 144 (86.9%) prioritized physical activity as moderately, very, or extremely important. Of 122 students, 81 (66.4%) exercised for at least 30 minutes on 3 or more of the past 7 days, and 36 (29.5%) reported doing so on 5 or more of the past 7 days. Nearly all of the students (127 of 133 [95.5%]) indicated that exercise is important for their future patients, 97 of 133 (72.9%) indicated feeling moderately or extremely comfortable counseling patients on exercise, and 113 of 134 (84.3%) desired to include physical activity counseling in their practice. Fifty of 134 students (40.3%) indicated that they were aware of current physical activity recommendations for adults in the United States; however, of these 50 students, 1 (2.0%) provided a correct definition of the national recommendations. Although students prioritized healthy lifestyles for themselves and their future patients and indicated a desire to include physical activity counseling as part of routine clinical care, the majority were unaware of the current physical activity recommendations. Thus, there is a need to address physical activity recommendations in the medical school curriculum.

Physical activity counseling in primary care: Insights from public health and behavioral economics.

Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. CA Cancer J Clin 2017;67:233-244. © 2017 American Cancer Society.

Developing physical activity counselling in primary care through participatory action approach.

BackgroundMany adults are insufficiently physically active for health. Counselling is the main method to promote physical activity (PA) in primary care but often implemented inadequately. The aim of this study was to increase health professionals’ i) know-how about health-related PA and PA counselling, ii) implementation and quality of PA counselling, iii) familiarity with and use of Physical Activity Prescription (PAP), iv) internal and external collaboration and v) use of electronic patient record system in PA counselling.MethodsFour Finnish health centres participated. Each nominated a working group for reaching the goals through a 6-month development work, which was supported with monthly tutorials by the research group. The outcome evaluation of the development work included 19 variables, which reflected the five goals and were assessed before (baseline) and after the development work (follow-up). Variable-specific differences in proportions (%) and their 95 % confidence intervals (CI) between the time points indicated change. The measures were questionnaires to the health professionals (N = 75 at baseline and N = 80 at follow-up) and patients (N = 441 and N = 431), professionals’ record sheets on patient visits (N = 1008 and N = 1000), and telephone interviews to external partners (N = 48 and N = 28). The process was evaluated with the extent the working group members participated in the development work and with the implementation of development actions. Assessment was based on meeting minutes of tutorials and working group meetings.ResultsHealth professionals’ familiarity with PAP (questionnaire, change 39 %-points; 95 % CI 26.5 to 52.5) and use of PAP (questionnaire, 32 %-points; 95 % CI 18.9 to 45.1 and record sheet, 4 %-points; 95 % CI 2.7 to 5.3) increased. A greater proportion of professionals had agreed in their working unit on using PAP (questionnaire, 32 %-points; 95 % CI 20.3 to 43.7) and used PAP as a referral to other health professionals (record sheet, 1 %-point; 95 % CI 0.3 to 1.7). Also the know-how of PA and PA counselling showed improvement but not statistically significantly. The working group members participated unevenly in the development work and had difficulties in allocating time for the work. This was seen in limited number of actions implemented.ConclusionsThe study was able to achieve some improvements in the familiarity with and use of PAP and to lesser extent in the know-how of health-related PA and PA counselling. To observe changes in other goals, which targeted more at organisational, inter-professional and multi-sectorial level, may have required more long-term actions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0540-x) contains supplementary material, which is available to authorized users.

Upgrading physical activity counselling in primary care in the Netherlands.

The systematic development of a counselling protocol in primary care combined with a monitoring and feedback tool to support chronically ill patients to achieve a more active lifestyle. An iterative user-centred design method was used to develop a counselling protocol: the Self-management Support Programme (SSP). The needs and preferences of future users of this protocol were identified by analysing the literature, through qualitative research, and by consulting an expert panel. The counselling protocol is based on the Five A's model. Practice nurses apply motivational interviewing, risk communication and goal setting to support self-management of patients in planning how to achieve a more active lifestyle. The protocol consists of a limited number of behaviour change consultations intertwined with interaction with and responses from the It's LiFe! monitoring and feedback tool. This tool provides feedback on patients' physical activity levels via an app on their smartphone. A summary of these levels is automatically sent to the general practice so that practice nurses can respond to this information. A SSP to stimulate physical activity was defined based on user requirements of care providers and patients, followed by a review by a panel of experts. By following this user-centred approach, the organization of care was carefully taken into account, which has led to a practical and affordable protocol for physical activity counselling combined with mobile technology.

System-level approaches to improving diabetes care: can asking simple questions improve exercise regimens for patients with diabetes?

Clin. Pract. (2014) 11(3), 243–245 ISSN 2044-9038 part of Physical activity is a cornerstone of the healthy lifestyle changes that most patients with Type 2 diabetes mellitus (DM2) must make to manage their condition [1,2]. Regular physical activity improves blood glucose control, blood pressure and quality of life, while lowering harmful cholesterol levels and decreasing cardiovascular events and mortality [1,3–5]. In a joint statement, the American Diabetes Association and American College of Sports Medicine recommend at least 150 min per week of moderate-to-vigorous physical activity (MVPA). MVPA should achieve approximately 40–60% of maximal aerobic capacity, which, for most people, is equivalent to brisk walking [1]. These recommendations, unfortunately, stand in stark contrast with the current reality in American society. Less than 10% of US adults achieve recommended levels of MVPA and over a third engage in no physical activity at all [6]. The twin epidemics of inactivity and overweight/obesity are directly responsible for over a fourth of US healthcare costs, a staggering US$700 billion dollars per year [7,8]. If the status quo remains, over 40% of Americans will be obese and over 50% will have diabetes or prediabetes by the year 2020 [9]. How then, does a modern health system address the daunting task of promoting physical activity in this current culture? Many middle-aged and older adults engage with the primary care setting on a regular basis (between four and eight clinical encounters per year), making this environment potentially highly suitable for implementing population-level programs focused on promoting physical activity [10,11]. Most primary care providers (PCPs), believing that physical activity is an important component of preventive health, report that they provide an integral role in engaging their patients to participate in regular exercise [12]. However, the lack of time and many competing demands during the typical primary care visit represent a significant barrier to adequately addressing physical inactivity. Moreover, despite the known importance of physical activity counseling in primary care, many providers still find it a challenge to provide detailed advice and less than a third of primary care visits include any exercise or lifestyle counseling at all [12–15]. As time constraints continue to tighten for most PCPs, new approaches are needed to help increase exercise levels in patients with diabetes. Clinicians and patients alike will need some assistance. With a prominent emphasis on and rewards provided for ‘meaningful use’ of electronic health records (EHRs) [16], health systems with robust EHRs can play an increasingly influential role in helping to address lack of physical activity. As these systems begin to share information across large populations, an electronic infrastructure is being developed to support clinicians and health systems interested in improving care. New approaches must now be developed and tested to leverage this electronic infrastructure. System-level approaches to improving diabetes care: can asking simple questions improve exercise regimens for patients with diabetes?

Clinician-targeted intervention and patient-reported counseling on physical activity.

IntroductionLimited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population. MethodsFamily medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre–post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians’ counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews.ResultsBoth patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0–15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program.ConclusionA clinician training intervention showed mixed results for 5As physical activity counseling.

A 5A's communication intervention to promote physical activity in underserved populations

BackgroundThe present study protocol describes the trial design of a clinician training intervention to improve physical activity counseling in underserved primary care settings using the 5As. The 5As (Ask, Advise, Agree, Assist, Arrange) are a clinical tool recommended for health behavior counseling in primary care.Methods/DesignThe study is a two-arm randomized pilot pragmatic trial to examine a primary care clinician communication intervention on use of the 5As in discussion of physical activity in audio-recorded office visits in an ethnically diverse, low-income patient population. The study setting consists of two federally qualified community health centers in Rochester, NY. Eligible clinicians (n=15) are recruited and randomized into two groups. Group 1 clinicians participate in the training intervention first; Group 2 clinicians receive the intervention six months later. The intervention and its outcomes are informed by self-determination theory and principles of patient-centered communication. Assessment of outcomes is blinded. The primary outcome will be the frequency and quality of 5As discussions as judged by evaluating 375 audio-recorded patient visits distributed over baseline and in the post-intervention period (immediately post and at six months). Secondary outcomes will be changes in patients’ perceived competence to increase physical activity (Aim 2) and patients and clinicians beliefs regarding whether pertinent barriers to promoting exercise have been reduced. (Aim 3). Exploratory outcomes (Aim 4) are potential mediators of the intervention’s effect and whether the intervention affects actual enrollment in the community program recommended for exercise. The analysis will use repeated measures (in the form of recorded office visits) from each clinician at each time point and aggregate measures of Groups 1 and 2 over time.DiscussionResults will help elucidate the role of 5As communication training for clinicians on counseling for physical activity counseling in primary care. Results will explore the effectiveness of the 5As model linked to community resources for physical activity promotion for underserved groups.

Evaluation of Physical Activity Counseling in Primary Care Using Direct Observation of the 5As

The 5As (ask, advise, assess, assist, arrange) are recommended as a strategy for brief physical activity counseling in primary care. There is no reference standard for measurement, however, and patient participation is not well understood. This study's objectives were to (1) develop a coding scheme to measure the 5As using audio-recordings of primary care visits and (2) describe the degree to which patients and physicians accomplish the 5As. We developed a coding scheme using previously published definitions of the 5As, direct-observation measures, and evaluation of audio-recorded discussions of physical activity. We applied the coding scheme to 361 audio-recorded visits by patients reporting low levels of physical activity and 28 physicians in northeast Ohio. The coding scheme achieved good inter-rater agreement for each of the 5As (κ = 0.62-1.0). A total of 135 visits included discussion of physical activity. Although ask tasks occurred in 91% of visits, it infrequently elicited sufficient detail about current activity. Patient readiness to change physical activity (assess) was infrequently directly elicited by the physician (24%), but readiness was commonly expressed by the patient in response to an assessment of current level of physical activity (53%). Ambivalence was infrequently followed by physician assistance (49%). Our newly developed measure showed that (1) physicians infrequently assess patient readiness to change, (2) patient expressions of ambivalence are common, and (3) specific mention of recommended guidelines for exercise is nearly absent. Future work should increase clinician skills in exploring ambivalence and readiness to change, as well as improve explicit mention of recommended guidelines for physical activity.

Interdisciplinary physical activity counseling in primary care

The Physical Activity Counseling randomized controlled trial integrated a physical activity (PA) counselor into a primary care practice to provide intensive counseling to sedentary patients following brief counseling from their regular health care provider. This article presents the voices of 15 patients, who through a series of 3 interviews, described their experience with this 3-month combined provider PA counseling intervention. Patient satisfaction was a dominant emergent theme, and the patients were particularly positive about the quality of care and educational support for lifestyle change. They favored the tailored approach and felt the strategies for overcoming PA barriers were helpful.

Exercise for Primary Care

This review discusses physical activity counseling in primary care, including evidence-based perspectives on optimizing the risk-benefit ratio for the majority of patients who are not physically fit.

Get moving! Physical activity counseling in primary care

The purpose of this article is to present strategies to improve the effectiveness of physical activity counseling for adults in primary care settings. Adoption of physical activity can be part of a healthy lifestyle to prevent or manage many chronic and debilitating conditions, including cardiovascular disease, diabetes, hypertension, and obesity. Original research articles reporting results from descriptive studies and clinical trials testing the effectiveness of physical activity counseling in primary care. Journal articles and Web sites are cited as patient and professional resources. Despite conflicting research findings on the effectiveness of physical activity counseling in primary care, the importance of an active lifestyle in promoting health and well-being is well known. Yet, only one third of all Americans attain adequate daily physical activity. Implementing physical activity counseling in primary care is one method to promote active lifestyles. Some strategies to promote physical activity counseling in primary care settings are identified, including use of the Five A's approach and printed materials. Suggestions to manage the barriers primary care providers experience with physical activity counseling include brief counseling sessions involving all members of the health team. The implementation of a brief physical activity counseling intervention in primary care settings is presented as a promising method to promote physical activity in adults. Nurse practitioners can deliver this counseling in a succinct, well-planned session to promote physical activity and reduce the potential devastating consequences associated with a sedentary lifestyle.

Physical activity counseling in primary care and patient well-being: Do patients benefit?

Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease. Benefits to health-related quality of life (HRQL) and subjective well-being may be as important and take less time to accrue. We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial (ACT), both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention. In ACT, 395 female and 479 male inactive patients ages 35 to 75 years were randomized to one of: physician advice, advice plus behavioral counseling during primary care visits, or advice plus behavioral counseling that also included telephone contact and behavioral classes. Participants were assessed at baseline, 6 months, and 24 months. HRQL was assessed as perceived quality of life, perceived stress, depression, and general health. Satisfaction with function and appearance, self-efficacy, and social support were also assessed. At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only. Men had reductions in daily stress across all treatment arms. These results mirrored VO2max changes observed per group. Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months. Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy.

Physical Activity Counseling in Primary Care

Physical Activity Counseling in Primary Care

DESIGN AND METHODS OF A MULTICENTER TRIAL OF PHYSICAL ACTIVITY COUNSELING IN PRIMARY CARE 1346

Few studies have examined long-term effects on physical activity and fitness of counseling in the primary care clinical setting. The Activity Counseling Trial is an NHLBI-sponsored multi-center randomized clinical trial to evaluate the efficacy of primary care physical activity behavioral interventions. About 810 sedentary generally healthy 35-75 year-old patients of primary care physicians are enrolled and randomly assigned to three groups. The control group receives physician advice; the two interventions groups receive one of two behavioral intervention programs that differ in resources required. Participants receive two years of intervention and follow-up. Primary outcome measures are: (1) kilocalories expended in physical activity(kcal·kg-1·day-1) measured by 7-day physical activity recall and (2) maximal oxygen uptake (VO2max)(L·min-1) measured by maximal treadmill test using a standardized protocol. Primary analyses will compare study groups on mean outcome measures at 2 years post-randomization, be adjusted for baseline value of outcome measure and multiple comparisons, and be conducted for men and women separately. Secondary outcomes include comparisons at six months of the primary outcome measures, factors related to cardiovascular disease (blood lipids/lipoproteins, blood pressure, body composition, plasma insulin, fibrinogen, dietary intake, smoking, heart rate variability), psychosocial effects, and cost-effectiveness. Identifying effective strategies for physical activity counseling in primary care should help increase physical activity nationwide.