Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients 2005 National Conference on Tobacco or Health.

Emerging Lessons of Achieving Emerging Lessons of Achieving Health Behavior Change in Primary Health Behavior Change in Primary

Care PatientsCare Patients

2005 National Conference on 2005 National Conference on

Tobacco or HealthTobacco or Health

PresentersPresenters

Helen Roemhild, MEd, CCRAHelen Roemhild, MEd, CCRA

Pamela Werb, MEd, CCRC, CCRAPamela Werb, MEd, CCRC, CCRA

Maribel Cifuentes, RNMaribel Cifuentes, RN

Kevin Peterson, MD, MPHKevin Peterson, MD, MPH

Tai Mendenhall, PhD, LMFTTai Mendenhall, PhD, LMFT

Minnesota Physicians Motivating Minnesota Physicians Motivating Health Improvement: Health Improvement:

The MINIT StudyThe MINIT Study

University of Minnesota Medical SchoolUniversity of Minnesota Medical SchoolDepartment of Family Medicine and Department of Family Medicine and

Community HealthCommunity Health

Research TeamResearch Team

Kevin Peterson Kevin Peterson Principal Principal InvestigatorInvestigator

Sharon Allen Sharon Allen Co-Investigator Co-Investigator

Tai Mendenhall Co-InvestigatorTai Mendenhall Co-Investigator

Helen Roemhild Technical AssistanceHelen Roemhild Technical Assistance

Pam Werb Technical AssistancePam Werb Technical Assistance

Mark Janowiec Computer ProgrammerMark Janowiec Computer Programmer

Richard Botehlo ConsultantRichard Botehlo Consultant

BackgroundBackground

Funded by the Robert Wood Johnson Funded by the Robert Wood Johnson Prescription for HealthPrescription for Health Initiative Initiative

Utilized Minnesota Academy of Family Utilized Minnesota Academy of Family Physicians Research Network (MAFPRN) Physicians Research Network (MAFPRN) for clinic recruitmentfor clinic recruitment

Minnesota Academy of Minnesota Academy of Family Physicians Family Physicians Research NetworkResearch Network

(MAFPRN)(MAFPRN)

MINIT StudyMINIT StudyClinic Sites & Local InvestigatorsClinic Sites & Local Investigators

Parkview Medical Clinic (New Prague)Parkview Medical Clinic (New Prague)

– Dan Berg, MD Dan Berg, MD

Park Nicollet Clinic (Minnetonka)Park Nicollet Clinic (Minnetonka)

– Don Pine, MD Don Pine, MD

Soteria Family Health Center (Plymouth)Soteria Family Health Center (Plymouth)

– Ruth Bolton, MD Ruth Bolton, MD

Phalen Village Clinic (St. Paul)Phalen Village Clinic (St. Paul)

– George Smith, MD George Smith, MD

Fairview – Eden Center Clinic (Eden Prairie)Fairview – Eden Center Clinic (Eden Prairie)

– David Johnson, MDDavid Johnson, MD

MINIT StudyMINIT StudyClinic Sites & Local Investigators Clinic Sites & Local Investigators (con’t)(con’t)

Family Practice Medical Center (Willmar)Family Practice Medical Center (Willmar)

– Mary Amon, MD Mary Amon, MD

Creekside Family Physicians (St. Louis Park)Creekside Family Physicians (St. Louis Park)

– Shannon Neale, MD Shannon Neale, MD

Payne Avenue Medical Clinic (St. Paul)Payne Avenue Medical Clinic (St. Paul)

– Sharon Allen, MD, Phd Sharon Allen, MD, Phd

CentraCare Clinic (Long Prairie)CentraCare Clinic (Long Prairie)

– Paul Van Gorp, MD Paul Van Gorp, MD

Starbuck Clinic (Starbuck)Starbuck Clinic (Starbuck)

– Stacy Luetmer, MD Stacy Luetmer, MD

MINIT Study SitesMINIT Study Sites

Minnesota

Community PartnersCommunity Partners

Blue Cross Blue Shield of MinnesotaBlue Cross Blue Shield of Minnesota

Hazelden FoundationHazelden Foundation

Park Nicollet FoundationPark Nicollet Foundation

Be Active MinnesotaBe Active Minnesota

Minnesota Partnership for Action Against Minnesota Partnership for Action Against TobaccoTobacco

HealthPartners, Inc.HealthPartners, Inc.

National Diabetes Education ProgramNational Diabetes Education Program

ObjectiveObjective

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

Number screened vs. number enrolled Number screened vs. number enrolled

Subject intervention mode preference Subject intervention mode preference

Stages of change movement Stages of change movement ((as determined as determined by a by a specific process measure tool at baseline, 30 and 180 daysspecific process measure tool at baseline, 30 and 180 days))

Subject engagement in interventionSubject engagement in intervention

Study GoalsStudy Goals

Determine the feasibility of a program to Determine the feasibility of a program to address unhealthy behaviors in primary address unhealthy behaviors in primary care patients who are not currently care patients who are not currently considering behavior changeconsidering behavior change

Target smoking, risky drinking, unhealthy Target smoking, risky drinking, unhealthy eating (obesity), sedentary lifestyleeating (obesity), sedentary lifestyle

DesignDesign

10 Primary Care Clinics10 Primary Care Clinics

18 Patients per clinic18 Patients per clinic

Recruited patients scheduled for periodic Recruited patients scheduled for periodic health exams or non-acute visitshealth exams or non-acute visits

Standardized screening toolsStandardized screening tools

Electronic real time enrollmentElectronic real time enrollment

Screening QuestionsScreening Questions

Do you smoke 10 cigarettes or more per Do you smoke 10 cigarettes or more per day?day?

Body Mass Index (BMI) ≥ 25Body Mass Index (BMI) ≥ 25

Do you exercise three or more times, or Do you exercise three or more times, or get 180 minutes or more of moderate get 180 minutes or more of moderate exercise (such as walking) per week?exercise (such as walking) per week?

5 Shot questionnaire for risky drinking5 Shot questionnaire for risky drinking

Consent and Study ProcessConsent and Study Process

Obtained consent Obtained consent

Provider delivered motivational messageProvider delivered motivational message

Scored for readiness to changeScored for readiness to change

Intervention selectionIntervention selection– Self help study guideSelf help study guide– Telephone intervention with motivational coach Telephone intervention with motivational coach

and self help study guideand self help study guide– Interactive computer intervention with motivational Interactive computer intervention with motivational

coach and online self help study guidecoach and online self help study guide

Online Intake SurveyOnline Intake Survey

Follow-up SurveyFollow-up Survey

Results: DemographicsResults: DemographicsTotalTotal eligible for enrollment (n = 114)eligible for enrollment (n = 114)Male Male 30% (n = 34) 30% (n = 34) Female Female 70% (n = 80)70% (n = 80)Ethnicity Ethnicity

CaucasianCaucasian 73% 73% (n = 83)(n = 83)Native American Native American 2% 2% (n = 03)(n = 03)African AmericanAfrican American 1% 1% (n = 01)(n = 01)Non-respondersNon-responders 24%24% (n = 27)(n = 27)

AgesAges18 – 2918 – 29 6% 6% (n = 5)(n = 5)30 – 3930 – 39 17% 17% (n = 15)(n = 15)40 – 49 25% (n = 22)40 – 49 25% (n = 22)50 – 64 35% (n = 40)50 – 64 35% (n = 40) 65+ 11%65+ 11% (n = 10) (n = 10)

Results: Study EnrollmentResults: Study Enrollment

SmokingSmoking

EatingEating

ExerciseExercise

Alcohol Alcohol

88 2424 1010

1111 1414 77

66 1515 1414

00 22 00

Self Help Telephone Computer

Results: Subject Recruitment and Results: Subject Recruitment and Intervention PreferenceIntervention Preference

Number of patients screened (n = 152)Number of patients screened (n = 152)Number of patients enrolled (n = 120)Number of patients enrolled (n = 120)

Intervention PreferenceIntervention Preference

39% Smoking39% Smoking31%31% Poor Diet Poor Diet31%31% Exercise Exercise

1% Risky Drinking1% Risky Drinking

Results: Study AttritionResults: Study Attrition

30 Day Follow-up30 Day Follow-up

telephone telephone (7%) (7%)

self-help self-help (19%)(19%)

computer computer (45%)(45%)

180 Day Follow-up180 Day Follow-up

telephone telephone (4%) (4%)

self-help self-help (18%)(18%)

computer computer (41%)(41%)

Results: Readiness to Change Results: Readiness to Change

30 Day follow-up30 Day follow-up

Percent of subjects moving fromPercent of subjects moving fromprecontemplative to contemplative or precontemplative to contemplative or contemplative to planning stagecontemplative to planning stage

55%55% Smoking Smoking (n = 31)(n = 31)83%83% Poor Diet Poor Diet (n = 20)(n = 20)77%77% Exercise Exercise (n = 22)(n = 22)

Results: Readiness to Change Results: Readiness to Change

180 Day Follow-up180 Day Follow-up

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

100%100% Smoking Smoking (n = 42)(n = 42)

100%100% Poor Diet Poor Diet (n = 32)(n = 32)100% 100% ExerciseExercise (n = 35)(n = 35)

SummarySummary

Patient preference for interventionPatient preference for intervention

AttritionAttrition

Screening protocolScreening protocol

Electronic real time enrollmentElectronic real time enrollment

Contact InformationContact Information

Kevin Peterson, MD MPHKevin Peterson, MD MPHUniversity of Minnesota Medical SchoolUniversity of Minnesota Medical SchoolDepartment of Family Medicine andDepartment of Family Medicine and

Community HealthCommunity Health925 Delaware Street SE, Suite 220925 Delaware Street SE, Suite 220Minneapolis, MN 55414Minneapolis, MN 55414

Email: [email protected]: [email protected]