AHA: Treat Unhealthy Behaviors as Aggressively as Disease Factors
Health care providers need to target unhealthy behaviors as seriously as physical risk factors in disease prevention, according to a forthcoming advisory statement from the American Heart Association.
The authors advocate a shift in delivery of care—that includes treating physical indicators like high blood pressure, high cholesterol, and other cardiovascular disease risk factors as well as treating unhealthy habits, such as tobacco use, poor diet, obesity, and lack of exercise.
“It is going to take a strong partnership between health professionals and the community to reverse the oncoming tide of chronic disease due to unhealthy lifestyle behaviors,” says Bonnie Spring, PhD, lead author of the statement and a professor of preventive medicine and psychiatry and behavioral sciences at Northwestern University in Chicago.
She and her coauthors encourage providers to help patients create plans to reach their own goals. Ask them to self-monitor steps toward behavioral change using a paper or web-based diary or mobile app, and encourage them to use rewards or incentives as reinforcement when they attain their goals.
Enlist the help of other professionals on your team. “We aspire to have the nurse or physician’s assistant routinely assess health behaviors as a vital sign, just as they now record biomarkers like blood pressure or weight,” Dr Spring says. “The physician is particularly authoritatively positioned to advise healthy lifestyle change, but then allied health professionals trained in behavioral change counseling may be better equipped and have more time to assist the patient in making changes.”
They suggest implementing the “five A’s” for better patient care as a team:
- Assess a patient’s risk behaviors for heart disease.
- Advise change, such as weight loss or exercise.
- Agree on an action plan.
- Assist with treatment.
- Arrange for follow-up care.
The statement recommends creating interprofessional practices to connect patients with behavior change specialists, such as dietitians, psychologists, and tobacco cessation experts.
“A key challenge that most health professionals face in collaborating with other disciplines is that we were trained separately and don’t fully understand each others’ expertise or skills,” Dr Spring says. “Holding occasional interdisciplinary grand rounds or case conferences with other neighborhood health professionals can begin to build a referral network, while also educating potential colleagues about what they have to offer each other.”
The second piece of the puzzle is advocating for improvements in reimbursement policies so that these behavioral change specialists can become part of the primary care practice team.
—Colleen Mullarkey
Reference
Spring B, Ockene JK, Gidding SS, Mozaffarian D, Moore S, Rosal MC, et al; on behalf of the American Heart Association Behavior Change Committee of the Council on Epidemiology and Prevention, Council on Lifestyle and Cardiometabolic Health, Council for High Blood Pressure Research, and Council on Cardiovascular and Stroke Nursing. Better population health through behavior change in adults: a call to action. Circulation. 2013 Nov;128. DOI: 10.1161/01.cir.0000435173.25936.e1. [Epub ahead of print].