Coordination of health behavior counseling in primary care

Deborah J. Cohen, Bijal A. Balasubramanian, Nicole F. Isaacson, Elizabeth C. Clark, Rebecca S. Etz, Benjamin F. Crabtree

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


PURPOSE We wanted to examine how coordinated care is implemented in primary care practices to address patients' health behavior change needs. METHODS Site visit notes, documents, interviews, and online implementation diaries were collected from July 2005 to September 2007 from practice-based research networks (PBRNs) participating in Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks (P4H). An iterative group process was used to conduct a cross-case comparative analysis of 9 interventions. Published patient outcomes reports from P4H interventions were referenced to provide information on intervention effectiveness. RESULTS In-practice health risk assessment (HRA) and brief counseling, coupled with referral and outreach to a valued and known counseling resource, emerged as the best way to consistently coordinate and encourage follow-through for health behavior counseling. Findings from published P4H outcomes suggest that this approach led to improvement in health behaviors. Automated prompts and decision support tools for HRA, brief counseling and referral, training in brief counseling strategies, and co-location of referral with outreach facilitated implementation. Interventions that attempted to minimize practice or clinician burden through telephone and Web-based counseling systems or by expanding the medical assistant role in coordination of health behavior counseling experienced diff culties in implementation and require more study to determine how to optimize integration in practices. CONCLUSIONS Easy-to-use system-level solutions that have point-of-delivery reminders and decision support facilitate coordination of health behavior counseling for primary care patients. Infrastructure is needed if broader integration of health behavior counseling is to be achieved in primary care.

Original languageEnglish (US)
Pages (from-to)406-415
Number of pages10
JournalAnnals of family medicine
Issue number5
StatePublished - 2011


  • Delivery of health care
  • Health behavior
  • Health promotion
  • Health services research
  • Outcomes and process assessment (health care)
  • Patient-centered care
  • Program evaluation
  • Quality improvement

ASJC Scopus subject areas

  • Family Practice


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