Krist Alex H, Woolf Steven H, Frazier Charles O, Johnson Robert E, Rothemich Stephen F, Wilson Diane B, Devers Kelly J, Kerns J William
Department of Family Medicine, Virginia Commonwealth University, Richmond, Virginia 23298-0251, USA.
Am J Prev Med. 2008 Nov;35(5 Suppl):S350-8. doi: 10.1016/j.amepre.2008.08.010.
A variety of factors limit the ability of clinicians to offer intensive counseling to patients with unhealthy behaviors, and few patients (2%-5%) are referred to the community counseling resources that do offer such assistance. A system that could increase referrals through an efficient collaborative partnership between community programs and clinicians could have major public health implications; such was the subject of this feasibility evaluation.
At nine primary care practices, an electronic linkage system (eLinkS) was instituted to promote health behavior counseling and to automate patient referrals to community counseling services. Patients were offered 9 months of free counseling for weight loss, smoking cessation, and problem drinking at a choice of venues: group counseling, telephone counseling, computer care, and usual care. The delivery of behavioral counseling, measured by the 5A's (ask, address, advise, assess, agree, arrange) and patients' reported experiences with eLinkS, was examined.
For 5 weeks eLinkS was used, until high referral volumes depleted counseling funds. Of the 5679 patients visiting the practices, 71% had an unhealthy behavior. Of these patients, 10% were referred for intensive counseling from a community program, most often for weight loss. Counseling and referrals occurred regardless of visit type--wellness, acute, or chronic care. eLinkS was used more often for middle-aged adults and women and by more-experienced clinicians.
The intervention increased the rate at which patients were referred for intensive behavioral counseling compared to current practice norms. Given the evidence that intensive counseling is more effective in promoting behavior change, implementing eLinkS could have substantial public health benefits.
多种因素限制了临床医生为有不健康行为的患者提供强化咨询的能力，很少有患者（2%-5%）被转介到能提供此类帮助的社区咨询资源处。一个能够通过社区项目与临床医生之间高效的合作关系来增加转介的系统可能会对公共卫生产生重大影响；这就是本可行性评估的主题。
在九个初级保健机构中，建立了一个电子链接系统（eLinkS），以促进健康行为咨询并使患者转介到社区咨询服务实现自动化。患者可在以下场所选择接受为期9个月的免费减肥、戒烟和戒酒咨询：团体咨询、电话咨询、计算机护理和常规护理。通过5A法（询问、关注、建议、评估、同意、安排）以及患者报告的使用eLinkS的经历来衡量行为咨询的提供情况。
eLinkS使用了5周，直到高转介量耗尽了咨询资金。在就诊的5679名患者中，71%有不健康行为。在这些患者中，10%被转介到社区项目接受强化咨询，最常见的是减肥咨询。无论就诊类型是健康体检、急症还是慢性病护理，都会进行咨询和转介。eLinkS在中年成年人和女性中以及经验更丰富的临床医生中使用得更多。
与当前的实践规范相比，该干预措施提高了患者被转介接受强化行为咨询的比例。鉴于有证据表明强化咨询在促进行为改变方面更有效，实施eLinkS可能会带来巨大 的公共卫生益处。
