The struggle to support patients' efforts to change their unhealthy behavior

  • Baron R
  • Desnouee E
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PRACTICE Greenhouse Internists, PC.
WHO AND WHERE Urban, community-based, five-physician, general internal
medicine practice serving about 9,000 economically and racially diverse
patients in Philadelphia, Pennsylvania.
CORE INNOVATIONS We hired a health educator who trained medical
assistants to help patients with chronic diseases set self-management
goals. The patients' personal action plans become part of their
electronic health records. An interactive Web site encourages patients
to share home blood pressure and glucose measurements with physicians.
KEY RESULTS In the first six months, 770 diabetic patients made office
visits, but only 230, or just under 30 percent, set self-management
goals using action plans written down on paper. Few patients have used
the Web site to share home management results. An electronic version of
the action plan form has not yet been fully implemented.
CHALLENGES Incorporating self-management support into patient visits
places increased demands on office staff, space, and work flow.
Developing a customized electronic action plan form was costly.
Fee-for-service payments to the practice are not high enough to cover
the salary of a health educator.

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  • Richard J. Baron

  • Emily Desnouee

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