Liana S. Lianov, MD, MPH

Disclosures

August 15, 2011

In This Article

The Challenge and Call to Duty

As the healthcare reform law is implemented, clinicians and the healthcare system will be challenged in offering effective prevention services. While we address payment and healthcare system reform issues, we cannot delay establishing the role of healthcare providers in prevention. In addition to more time during the clinical encounter, providers need training and the ability to link to community resources, because successfully promoting health behavior change among patients requires skill, diligence, and interventions at multiple levels.

Behavior change is not easy. Lack of motivation and environmental factors are powerful influences on patient behavior and can overshadow the role of the clinician prescription. However, behavior can be successfully influenced by simultaneous interventions that address intrapersonal beliefs, interpersonal support (including support from healthcare providers!), community and social networks, institutional regulations and policies, and public policy.

Patients often cite their healthcare provider's advice as an important factor that led to successful behavior change.[10] Evidence for behavioral influence by clinicians is ample.[11,12,13,14,15,16,17,18,19,20,21,22,23] Evidence supports the positive effect of providers on patient physical activity [24,25]as well as on eating behavior.[10,26,27,28,29,30,31]

This scientific foundation for the role of the primary care clinician in behavioral counseling is summarized by the United States Preventive Services Task Force (USPSTF) recommendations of an "A" grade for smoking cessation counseling[32] and "B" grade for dietary counseling for at-risk patients[33] and counseling for reduction of risky alcohol consumption.[34] Unfortunately, the data do not support counseling for physical activity and nutrition for primary prevention in the primary care setting. This may not necessarily reflect lack of efficacy or importance of the prescribing role of the clinician, but rather the complexity of the issue under study. Studies of interventions that address comprehensive health behavior change at multiple levels with the prescribing healthcare provider as one component are challenging, if not impossible, to conduct. In view of the complexity of the issue, as clinicians, we may be getting in our own way if we rely solely on scientific evidence. What rests squarely on our shoulders is our own lack of self efficacy to prescribe lifestyle medicine and our inability to effectively leverage interdisciplinary teams and community resources to achieve positive patient outcomes.

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