Article Figures & Data
Figures
- Figure 1.
The Action Plan Form 〈www.familymedicine.medschool.ucsf.edu/research/research_programs/actionPlan.aspx〉.
Tables
Safety Net (n = 128) (%) Private Practice (n = 146) (%) Overall (n = 274) (%) Completed action plans 82 84 83 Clinician post-action plan discussion questionnaires returned 92 92 92 For patients with action plan 93 93 93 For patients without action plan 86 87 86 Clinician reasons for not completing action plans* Patient too ill 44 15 29 Too little time 28 50 39 Patient not interested 17 10 13 Other 11 25 18 Clinician satisfaction with discussion† No different than previous behavior change discussions 32 24 28 Less satisfying than previous discussions 8 6 7 More satisfying than previous discussions 42 50 47 Not applicable‡ 16 16 16 Question not answered <1 4 3 Estimated time to complete action plan discussions (minutes)§ Safety Net (n = 93) Private Practice (n = 113) Overall (n = 216) Average Range Average Range Average Range 6.9 1 to 20 6.8 1 to 20 6.9 1 to 20 SD 4.5 4.1 4.32 * Mantel-Haenszel χ2; P = .03
† Response to question: ′Was today’s discussion about behavior change more satisfying, less satisfying, or no different than previous behavior change discussions with this patient (or not applicable)?′
‡ Patients for whom an action plan was not developed for reasons of time, patient illness, new patient, etc.
§ For 12 action plans discussions, clinicians did not estimate the time; thus the n = 216 rather than 228.
a. In general, do you feel that action plans make behavior change discussions: Easier? The same? Harder? Private practice (N = 21) 52% 43% 5% Safety net (N = 18) 61% 22% 17% Overall (N = 39) 56% 33% 10% Clinician Post-study Ratings of the Acceptability and Usability of Action Plan Methods Yes No b. Did the study change the way you like to discuss health behavior with patients? Private practice 62% 38% Safety net 89% 11% Overall 74% 26% c. Did you use action plans with patients outside the study? Private practice 76% 24% Safety net 72% 28% Overall 74% 26% d. Have you recommended the action plan idea to other clinicians? Private practice 43% 57% Safety net 22% 78% Overall 33% 67% e. Will you continue to use the action plan with some of your patients? Private practice 81% 19% Safety net 83% 17% Overall 82% 18% f. Should all primary care clinicians be trained in the use of action plans? Private practice 86% 14% Safety net 89% 11% Overall 87% 13% Clinician Post-study Assessment of Action Plan Effectiveness g. Do you think Action Plans can be helpful in encouraging behavior change? No Rare patients Some patients Most patients Private practice 0% 0% 67% 33% Safety net 0% 6% 59% 35% Overall 0% 3% 64% 33% Clinician Post-study Assessment of Barriers to Goal-setting Discussions h. What is the barrier that makes it most difficult to use Action Plans in primary care visits?* Time Methods† Other Resources Private practice 67% 38% 10% 5% Safety net 65% 41% 0% 29% Overall 66% 39% 5% 21% Clinician Opinion on Goal-setting by Other Health Caregivers i. Do you think it would be more appropriate for other caregivers to engage patients in goal setting since physicians have very little time? Yes No Private practice (N = 21) 52% 48% Safety net (N = 18) 67% 33% Overall (N = 39) 59% 41% j. If “Yes,” what type of caregiver would be appropriate? Health Educators Medical Assistants Nurses Social Workers Private practice 67% 29% 57% 29% Safety net 67% 33% 61% 39% Overall 67% 31% 59% 33% * More than one barrier was identified by some clinicians.
† Methods refers to difficulties associated with using action plan forms and engaging in collaborative discussions.
Topic Quotes Practice Setting Time “… that was the big inhibition for me—the time factor. When patients come here they often have four or five issues, and you can’t add another thing.” Private practice “… it’s difficult when it’s busy and it’s difficult not to be directive. Being directive doesn’t take much time.” Private practice “… [the action plan] helped me prioritize that as opposed to the 16 other priorities …” Safety net Resources “It would be kind of nice to have an appointment just to talk about the action plan.” Private practice “Anything that adds more paper is a problem.” Safety net “[The action plan] made it more real and achievable for patients to set goals … and by doing that and calling them back a week later it was extremely helpful for them… . It would be really nice if we could continue that. We don’t have the resources to do that.” Private practice General comments “It would be hard to totally let [the action plan] be patient-driven.” Safety net “I get to the point where I say, ‘The action plan is you’re going to take a lipid-lowering medicine, you’re going to take it for 4 weeks, here’s the lab slip.’ ” Private practice “The emphasis on getting patients to assume some responsibility for their own care is good.” Private practice “… paring down to one thing, pin it down, that was a shift for me.” Safety net “[The action plan] really gives you a chance for buy in and I found it’s more successful to give them a chance to talk about their health and what’s important for them, so I like it.” Safety net “When a patient didn’t do the action plan I was flummoxed. I didn’t know what to do next.” Private practice “I really felt like [the action plan] impacted the way I did health education with lots and lots of patients … ” Safety net “I felt disappointed when patients did not reach their goals, even if they only did 50%.” Private practice “If an action plan comes up naturally in a visit then it’s a good idea.” Private practice “I like the concept, but most doctors, and probably myself, will do [action plans] for a while and then go back to the old pattern of yelling at the patients to change their behaviors—because that is how we were taught.” Private practice Other caregivers “I think [the action plan] would be much better for the non-clinician to do, because of time.” Private practice “I think it would be empowering for our nurses to do action plans when they’re not busy doing other stuff.” Safety net “… if we had our nurse and MAs trying to do [action plans] it would slow things down even more.” Safety net “All those medical assistants, health educators, social workers, that would be awesome if they could [do action plans] before or after the visit.” Private practice
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