Background The North County Health Centre in Reston, Virginia, recently enhanced the quality and accessibility of physician-coordinated behavioural counselling. Methods A patient survey confirmed that the clinic could improve behaviour change support. Physician time constraints, practice productivity issues and treatment priorities were identified barriers to systems change. Systems changes included teamwork, group visits, community engagement and trusted online consumer resources. Validated statistical process control (SPC) techniques evaluated variation in monthly 90-minute group visits for Spanish- and English-speaking patients during which we reviewed evidence-based recommendations, hosted community speakers and held brief individual encounters using encounter forms with built-in motivational interviewing techniques Results Onaverage, four English-speaking patients attended, with 42% of the participants who attended more than one meeting successfully achieving their self-reported goal. On average, nine Spanish-speaking patients attended, with eight (86%) of the participants achieving their goals. Documentation of recorded prevention counselling improved from 15% to 67%. Patients indicated that they found that what they learned is transferable to their everyday lives. Conclusion The total number of patient encounters in a clinical session did not dramatically change. Language preference was not a hurdle. Teamwork among patients, providers, staff and community members was a key to success. Group visits improved the amount of prevention counselling and helped patients with limited health literacy achieve their prevention goals.
Kristin M Anderson, Seth C Holloway, Nafeesa Sultana, Wendy E Braund, Linda M Harris, Lilly VK Siems