Top Things to Know: Health Behavior Change Programs in Primary Care and Community Practices for Cardiovascular Disease Prevention and Risk Factor Management Among Midlife and Older Adults
Published: November 04, 2021
- Cardiovascular disease (CVD) is a major burden among middle age and older adult populations worldwide. Progress made towards improving population-wide cardiovascular health has been offset by stagnant or worsening trends in cardiovascular health behaviors and risk factors.
- Comprehensive, evidenced-based behavioral counseling interventions in primary care is a recommended first-line approach for promoting healthy behaviors and preventing CVD outcomes in at-risk adults.
- Grounded in theory-based behavior change principles, the 5 A model (assess, advise, agree, assist, arrange) is a clinical framework that guides the process of brief and focused behavior counseling in clinical settings.
- “Assisting” patients in achieving health behavior goals and “arranging” follow-up support are important steps in health behavior counseling in primary care and considered essential to effectively promote meaningful and lasting behavior change. However, these steps are delivered the least often by clinicians.
- This Scientific Statement is intended to encourage health care professional efforts to adopt and implement comprehensive, evidence-based behavior counseling interventions in primary care or community-based settings for primary CVD prevention.
- Health behavioral change programs conducted in primary care settings have effectively shown to improve body weight and blood pressure, diet and physical activity. Clinician-facilitated, behavior counseling interventions may also be effective at improving cardiovascular health in underrepresented populations.
- Behavior change programs that utilize team-based care, reimbursement and referral models are practical approaches to appropriately engage and refer patients to behavior change programs.
- Provisions in national coverage and reimbursement schemes have been made to strengthen the coordination of care and facilitate the delivery of intensive behavioral counseling in primary care settings.
- Insufficient or absent reimbursement remains a burdensome financial barrier faced by healthcare professionals. Cumbersome regulation of reimbursement further impedes effective adoption and implementation of behavior counseling in primary care practice.
- Identifying best-practice approaches to improve the feasibility and broadscale delivery of evidence-based behavior counseling interventions within clinical and community settings is needed. Effective approaches that promote health equity when delivering lifestyle behavior counseling interventions to diverse and medically under-resourced populations is critical for effectively reducing CVD disparities.
Citation
Laddu D, Ma J, Kaar J, Ozemek C, Durant RW, Campbell T, Welsh J, Turrise S; on behalf of the American Heart Association Behavioral Change for Improving Health Factors Committee of the Council on Epidemiology and Prevention and the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; and Stroke Council. Health behavior change programs in primary care and community practices for cardiovascular disease prevention and risk factor management among midlife and older adults: a scientific statement from the American Heart Association [published online ahead of print November 4, 2021]. Circulation. doi: 10.1161/CIR.0000000000001026