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Evaluating Feasible and Referable Behavioral Counseling Interventions

Alex H. Krist, MD, MPH; Linda J. Baumann, PhD, RN; Jodi Summers Holtrop, PhD, MCHES; Melanie R. Wasserman, PhD; Kurt C. Stange, MD; PhD, Meghan Woo, ScD, ScM


September 4, 2015
Unhealthy behaviors are an important cause of excess morbidity and premature mortality — potentially more significant than genetic, biological, or environmental factors. Primary care clinicians are uniquely situated to play a pivotal role in helping patients improve health behaviors through behavioral counseling interventions (BCIs). This role is facilitated by the Affordable Care Act of 2010, which requires insurers to cover BCIs that are recommended and given a grade of A or B by the U.S. Preventive Services Task Force (USPSTF).

The USPSTF has long recognized the importance of BCIs in primary care and has developed an analytic framework to evaluate the evidence supporting them. The USPSTF evaluation assesses whether:
·         An intervention in the clinical setting influences patients to change behaviors; and
·         Changing behaviors improves health outcomes with minimal harms.

Although the USPSTF has recommended the provision of a growing number of BCIs, many are not routinely offered to the patients who need them or are poorly delivered and fail to result in meaningful health behavior changes. Research is needed to improve the design and evaluation of BCIs so that they can be more effectively delivered in primary care and the community.

This manuscript reports on the perspectives of a BCI Expert Forum convened by the USPSTF on November 26, 2013 to better advance the evidence and evaluation of BCIs to ensure their feasibility. Participants included stakeholders from the USPSTF, federal agencies, research community, and primary care community.

Read a related article: Understanding Research Gaps and Priorities for Improving Behavioral Counseling Interventions
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