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Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients. 2005 National Conference on Tobacco or Health. Presenters. Helen Roemhild, MEd, CCRA Pamela Werb, MEd, CCRC, CCRA Maribel Cifuentes, RN Kevin Peterson, MD, MPH Tai Mendenhall, PhD, LMFT.

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emerging lessons of achieving health behavior change in primary care patients
Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients

2005 National Conference on

Tobacco or Health

presenters
Presenters

Helen Roemhild, MEd, CCRA

Pamela Werb, MEd, CCRC, CCRA

Maribel Cifuentes, RN

Kevin Peterson, MD, MPH

Tai Mendenhall, PhD, LMFT

minnesota physicians motivating health improvement the minit study

Minnesota Physicians Motivating Health Improvement: The MINIT Study

University of Minnesota Medical School

Department of Family Medicine and Community Health

research team
Research Team
  • Kevin Peterson Principal Investigator
  • Sharon Allen Co-Investigator
  • Tai Mendenhall Co-Investigator
  • Helen Roemhild Technical Assistance
  • Pam Werb Technical Assistance
  • Mark Janowiec Computer Programmer
  • Richard Botehlo Consultant
background
Background
  • Funded by the Robert Wood Johnson Prescription for Health Initiative
  • Utilized Minnesota Academy of Family Physicians Research Network (MAFPRN) for clinic recruitment
minit study clinic sites local investigators
MINIT StudyClinic Sites & Local Investigators
  • Parkview Medical Clinic (New Prague)
    • Dan Berg, MD
  • Park Nicollet Clinic (Minnetonka)
    • Don Pine, MD
  • Soteria Family Health Center (Plymouth)
    • Ruth Bolton, MD
  • Phalen Village Clinic (St. Paul)
    • George Smith, MD
  • Fairview – Eden Center Clinic (Eden Prairie)
    • David Johnson, MD
minit study clinic sites local investigators con t
MINIT StudyClinic Sites & Local Investigators (con’t)
  • Family Practice Medical Center (Willmar)
    • Mary Amon, MD
  • Creekside Family Physicians (St. Louis Park)
    • Shannon Neale, MD
  • Payne Avenue Medical Clinic (St. Paul)
    • Sharon Allen, MD, Phd
  • CentraCare Clinic (Long Prairie)
    • Paul Van Gorp, MD
  • Starbuck Clinic (Starbuck)
    • Stacy Luetmer, MD
community partners
Community Partners
  • Blue Cross Blue Shield of Minnesota
  • Hazelden Foundation
  • Park Nicollet Foundation
  • Be Active Minnesota
  • Minnesota Partnership for Action Against Tobacco
  • HealthPartners, Inc.
  • National Diabetes Education Program
objective
Objective

The aim of this pilot study was to assess subject recruitment issues including:

  • Number screened vs. number enrolled
  • Subject intervention mode preference
  • Stages of change movement (as determined by a specific process measure tool at baseline, 30 and 180 days)
  • Subject engagement in intervention
study goals
Study Goals
  • Determine the feasibility of a program to address unhealthy behaviors in primary care patients who are not currently considering behavior change
  • Target smoking, risky drinking, unhealthy eating (obesity), sedentary lifestyle
design
Design
  • 10 Primary Care Clinics
  • 18 Patients per clinic
  • Recruited patients scheduled for periodic health exams or non-acute visits
  • Standardized screening tools
  • Electronic real time enrollment
screening questions
Screening Questions
  • Do you smoke 10 cigarettes or more per day?
  • Body Mass Index (BMI) ≥ 25
  • Do you exercise three or more times, or get 180 minutes or more of moderate exercise (such as walking) per week?
  • 5 Shot questionnaire for risky drinking
consent and study process
Consent and Study Process
  • Obtained consent
  • Provider delivered motivational message
  • Scored for readiness to change
  • Intervention selection
    • Self help study guide
    • Telephone intervention with motivational coach and self help study guide
    • Interactive computer intervention with motivational coach and online self help study guide
results demographics
Results: Demographics
  • Totaleligible for enrollment (n = 114)
  • Male 30% (n = 34)
  • Female 70% (n = 80)
  • Ethnicity

Caucasian 73% (n = 83)

Native American 2% (n = 03)

African American 1% (n = 01)

Non-responders 24% (n = 27)

  • Ages

18 – 29 6% (n = 5)

30 – 39 17% (n = 15)

40 – 49 25% (n = 22)

50 – 64 35% (n = 40)

65+ 11% (n = 10)

slide20

Results: Study Enrollment

Self Help Telephone Computer

results subject recruitment and intervention preference
Results: Subject Recruitment and Intervention Preference

Number of patients screened (n = 152)

Number of patients enrolled (n = 120)

Intervention Preference

39% Smoking

31% Poor Diet

31% Exercise

1% Risky Drinking

results study attrition
Results: Study Attrition

30 Day Follow-up

telephone (7%)

self-help (19%)

computer (45%)

180 Day Follow-up

telephone (4%)

self-help (18%)

computer (41%)

results readiness to change
Results: Readiness to Change

30 Day follow-up

Percent of subjects moving from

precontemplative to contemplative or

contemplative to planning stage

55% Smoking (n = 31)

83% Poor Diet (n = 20)

77% Exercise (n = 22)

results readiness to change1
Results: Readiness to Change

180 Day Follow-up

Percent of subjects changing from precontemplative to contemplative or contemplative to planning stage

100% Smoking (n = 42)

100% Poor Diet (n = 32)

100% Exercise (n = 35)

summary
Summary
  • Patient preference for intervention
  • Attrition
  • Screening protocol
  • Electronic real time enrollment
contact information
Contact Information

Kevin Peterson, MD MPH

University of Minnesota Medical School

Department of Family Medicine and

Community Health

925 Delaware Street SE, Suite 220

Minneapolis, MN 55414

Email: peter223@umn.edu