Donald H. Gemson

Office system interventions supporting primary care-based health behavior change counseling.

CONTENT This article reviews the literature on the effectiveness of office system interventions to improve behavior-change counseling in primary care. These instructions consist of two principle components: tools and teamwork. Tools have been developed to assist providers with health risk assessment (questionnaires, health risk appraisals), prompting and reminding (chart stickers, checklists, flow charts, reminder letters), and education (manuals and handbooks). Teamwork entails the coordination and delegation of tasks between providers and staff. CONCLUSIONS A number of clinical trials, particularly in the area of smoking cessation, have demonstrated the effectiveness of tools and teamwork for increasing counseling rates and counseling effectiveness. Although no one type of tool or method of teamwork is consistently more effective than another-with effectiveness varying according to practice, provider, and patient characteristics-the use of different tools and teamwork approaches leads to additive improvements in counseling and patient behavior-change rates. More high-quality research is needed, particularly in the areas of health risk assessment and electronic reminder systems, to develop effective office interventions that can be readily implemented into a wide variety of primary care practices.

Risk factors for excess mortality in harlem: Findings from the harlem household survey

INTRODUCTION In 1980, age-adjusted mortality rates in Central Harlem were the highest among New York Citys 30 health districts. This population-based study was designed to describe the self-reported frequency of selected health conditions, behavioral risk factors, preventive health practices, and drug use in the Harlem community. METHODS From 1992 to 1994, in-person interviews were conducted among 695 adults aged 18 to 65 years who were randomly selected from dwelling-unit enumeration lists for the Central Harlem health district. Descriptive statistics were computed for men and women separately, and compared to other population-based surveys. RESULTS Self-reported medical insurance coverage in Harlem was unexpectedly high (74% of men, 86% of women) as was lifetime use of preventive health practices, e.g., blood cholesterol screening (58% of men, 70% of women). However, lifetime rates of substance use, e.g. crack cocaine (14%) and self-reported history of traumatic events, e.g., witnessing someone seriously injured or violently killed (49% of men, 21% of women) were also high in Harlem, especially in comparison to other populations. CONCLUSIONS This study has identified important patterns of similarities and differences in risk behaviors between Harlem and other populations. Potential solutions to the health problems of Harlem may lie in the creation of strategies that operate at the community, municipal, and regional level, as well as at the level of individual behavior and risk-taking.

Cancer screening and prevention practices of inner-city physicians.

INTRODUCTION Effective preventive services are needed most in underserved, inner-city settings that suffer disproportionately from morbidity and mortality. Primary care physicians can play an important role in the provision of efficacious cancer prevention and screening services to patients in these communities. METHOD We surveyed 122 primary care physicians about their cancer prevention and screening knowledge, attitudes, and practices. RESULTS Relative to the findings from national and local surveys, sample physicians were not as knowledgeable about national guidelines for preventive care, were less likely to counsel on smoking cessation, and were less likely to advise diet modification. Although physician practices reflected national cancer prevention and screening guidelines in general, a significant proportion of physicians suggested lung and prostate cancer screening tests that were inconsistent with national recommendations. CONCLUSIONS Systematic efforts are needed to increase the knowledge and practices of inner-city physicians concerning cancer prevention and screening.

Cancer education among primary care physicians in an underserved community

Abstract Introduction: Urban minority groups, such as those living in north Manhattan, are generally underserved with regard to cancer prevention and screening practices. Primary care physicians are in a critical position to counsel their patients on these subjects and to order screening tests for their patients. Methods: Eighty-four primary care physicians in two intervention communities who received educational visits about cancer screening and prevention were compared with 38 physicians in a nearby community who received no intervention. With pre- and post-test interviews over an 18-month period, the physicians were asked about their attitudes toward, knowledge of (relative to American Cancer Society guidelines), and likelihood of counseling and screening for breast, cervical, colorectal, and prostate cancers. Results: Comparison of the two surveys of physicians indicated no statistically significant differences in knowledge of cancer prevention or screening. At post-test, however, intervention group physicians identified significantly fewer barriers to practice than control physicians ( p Conclusions: We uncovered significant changes in attitude due to academic detailing among urban primary care physicians practicing in north Manhattan. A significant pre-test sensitization effect and small numbers may have masked overall changes in cancer prevention and screening behaviors among physicians due to the intervention.

Efficacy of Computerized Health Risk Appraisal as Part of a Periodic Health Examination at the Worksite

Purpose. To evaluate the efficacy of computerized health risk appraisal (HRA) when it is incorporated into a periodic health examination at the worksite. Design. A randomized, controlled trial comparing change in health behaviors for a 6-month follow-up period was conducted. Setting. A large financial services firm in New York City. Subjects. A total of 161 employees who volunteered for a worksite periodic health examination. Intervention. All employees received a physician-based history and physical examination, including laboratory tests, and were counseled on the basis of the results. Half the employees were randomly assigned, to receive an HRA report, with counseling from the 1984 version of the Centers for Disease Control HRA, whereas the other half completed the HRA questionnaire but received no HRA report or counseling. Measures. Blood pressure, cholesterol, and weight were measured by project staff physical activity and seatbelt use were measured by self-report, and change in computerized appraised age was calculated by the HRA program. Results. Evaluation of the 90 participants who returned for follow-up revealed a statistically significant improvement in computerized appraised age and physical activity in those who had received the HRA report and counseling compared with those who had not (p <.05), and also showed trends toward greater improvement in blood pressure, weight, and seatbelt use. Conclusions. Results provide support for the efficacy of HRA when incorporated into a periodic health examination at the worksite.