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The impact of behavioral and mental health risk assessments on goal setting in primary care

  • Original Research
  • Published:
Translational Behavioral Medicine

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

Author information

Authors and Affiliations

  1. Department of Family Medicine and Population Health, Virginia Commonwealth University, PO Box 980101, Richmond, VA, 23298, USA

    Alex H. Krist

  2. Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA

    Russell E. Glasgow

  3. Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Suzanne Heurtin-Roberts

  4. Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA

    Roy T. Sabo

  5. Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA

    Roy T. Sabo

  6. Division of Cancer Control and Population Sciences (Leidos Biomedical Research, Inc.), National Cancer Institute, Rockville, MD, USA

    Sherri N. Sheinfeld Gorin

  7. Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, USA

    Bijal A. Balasubramanian

  8. Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, USA

    Paul A. Estabrooks & Sallie Beth Johnson

  9. Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA

    Paul A. Estabrooks & Sallie Beth Johnson

  10. Department of Health Promotion and Community Health Sciences, Texas A&M Health Sciences Center School of Public Health, College Station, TX, USA

    Marcia G. Ory

  11. Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Beth A. Glenn

  12. Department of Preventive Medicine, Northwestern University, Chicago, IL, USA

    Siobhan M. Phillips

  13. Department of Family Medicine, University of Vermont, Burlington, VT, USA

    Rodger Kessler

  14. Consortium for Implementation Science, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

    Catherine L. Rohweder

  15. School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA

    Maria E. Fernandez

  16. School of Public Health, University of Maryland, College Park, MD, USA

    Dylan H. Roby

Authors
  1. Alex H. Krist
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  2. Russell E. Glasgow
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  3. Suzanne Heurtin-Roberts
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  4. Roy T. Sabo
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  5. Dylan H. Roby
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  6. Sherri N. Sheinfeld Gorin
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  7. Bijal A. Balasubramanian
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  8. Paul A. Estabrooks
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  9. Marcia G. Ory
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  10. Beth A. Glenn
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  11. Siobhan M. Phillips
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  12. Rodger Kessler
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  13. Sallie Beth Johnson
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  14. Catherine L. Rohweder
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  15. Maria E. Fernandez
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Consortia

For The MOHR Study Group

Corresponding author

Correspondence to Alex H. Krist.

Ethics declarations

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.

Conflict of interest

The authors declare that they have no conflicts of interest.

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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

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