Policy tools for building health education and preventive counseling into managed care

An Assessment of Certified Health Education Specialists’ Attitudes on Direct Third-Party Reimbursement for Health Education Services

This study used a valid questionnaire to assess certified health education specialists’ (CHES) opinions regarding issues of seeking payment from insurance companies (third-party reimbursement) for health education services. A total of 1,942 usable questionnaires were returned, and the responses were used for data analysis. Results from descriptive statistics indicated that the participants acknowledged both the potential advantages and disadvantages associated with seeking direct third-party reimbursement (DTPR) for health education services. In addition, study results suggested positive attitudes among the participants regarding DTPR. However, study results also indicated existing reservations among the participants in terms of the feasibility of seeking DTPR. Inferential statistics indicated that all demographic factors except race had no influence on participants’ attitudes toward seeking DTPR. Discussions of the study results and recommendations for the health education profession are provided.

Anogenital Warts Knowledge and Counseling Practices of US Clinicians: Results From a National Survey

OBJECTIVES

To examine messages US clinicians use when counseling patients diagnosed with anogenital warts.

STUDY DESIGN

In mid-2004, we conducted a confidential mail survey of nationally representative samples of physicians practicing internal and adolescent medicine, family/general practice, obstetrics/gynecology, urology, or dermatology; nurse midwives; physician assistants; and nurse practitioners. The survey assessed knowledge and counseling practices of clinicians who had diagnosed anogenital warts.

RESULTS

After adjusting for survey eligibility, 81% responded. Most (89%) were aware that human papillomavirus (HPV) causes anogenital warts, but only 48% were aware that oncogenic and wart-related HPV genotypes usually differ. Most (>95%) clinicians reported telling patients with warts that warts are an STD, are caused by a virus, or that their sex partners may have or may acquire warts. Many clinicians (>/=85%) also reported discussing STD prevention or assessing STD risk with such patients. Most reported addressing ways to prevent HPV (89%), including using condoms; limiting sex partners or practicing monogamy; or abstinence. Many also reported recommending prompt (82%) or more frequent (52%) Pap testing to female patients with anogenital warts. Potential barriers to counseling included providing definitive answers on how HPV infection was acquired, dealing with patients' psychosocial issues, and inadequate reimbursement.

CONCLUSIONS

Most surveyed clinicians appropriately counseled patients about the cause and prevention of anogenital warts. However, many clinicians were unaware that oncogenic and wart-related HPV types usually differ, and this may explain why many reported recommending more aggressive cervical cancer screening for female patients with warts.

Sexually Transmitted Disease Care in Managed Care Organizations

Most STD cases in the United States are managed in health sectors dominated by commercial and Medicaid MCOs. To sustain the recent declines in bacterial STD incidence in the United States and to control expansion of the prevalent viral STD, MCOs will need to contribute substantially to control efforts. Applied researchers and quality improvement specialists must work with clinicians, patients, and health systems to develop and scale-up interventions to improve STD prevention and control.

Utilizing "PPIP Texas style!" in a medically underserved population

Implementation models, such as the national Put Prevention Into Practice program, have produced small to moderate changes in the delivery of preventive services in primary care. More recently, researchers concluded that guides and tools, such as the PPIP toolkit, are helpful, but are not sufficient to facilitate substantive change in clinical preventive practice. Successful implementation of clinical preventive services, according to the Texas Department of Health-PPIP (TDH-PPIP) initiative, involves creating or altering systems to produce change in service delivery for a specific setting. This article describes the ways in which the guidelines and instruments that were developed and refined through the collaborative efforts among public and private health systems were used to implement systems change and improve clinical preventive services at one community primary health care clinic in Texas. The process and empirical results of using the TDH-PPIP Implementation Model in the field are also presented, as well as a discussion of one-year evaluation data.

A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP)

BACKGROUND

The potential of primary care practice settings to prevent disease and morbidity through health habit counseling, screening for asymptomatic disease, and immunizations has been incompletely met. This study was designed to test a practice-tailored approach to increasing preventive service delivery with particular emphasis on health habit counseling.

DESIGN

Group randomized clinical trial and multimethod process assessment.

SETTING/PARTICIPANTS

Seventy-seven community family practices in northeast Ohio.

INTERVENTION

After a 1-day practice assessment, a nurse facilitator met with practice clinicians and staff and assisted them with choosing and implementing individualized tools and approaches aimed at increasing preventive service delivery.

MAIN OUTCOME MEASURE

Summary scores of the health habit counseling, screening and immunization services recommended by the U.S. Preventive Services Task Force up to date for consecutive patients during randomly selected chart review days.

RESULTS

A significant increase (p=0.015) in global preventive service delivery rates at the 1-year follow-up was found in the intervention group (31% to 42%) compared to the control group (35% to 37%). Rates specifically for health habit counseling (p=0.007) and screening services (p=0.048) were increased, but not for immunizations.

CONCLUSIONS

An approach to increasing preventive service delivery that is individualized to meet particular practice needs can increase global preventive service delivery rates.

Preventive counseling during prenatal care: Pregnancy Risk Assessment Monitoring System (PRAMS)

BACKGROUND

Prenatal care provides an opportunity for counseling about behaviors and experiences that increase the likelihood of adverse maternal and fetal outcomes.

OBJECTIVE

To document (1) prevalence of preventive health counseling during prenatal care, (2) prevalence of women in higher need of counseling about specific health concerns, and (3) whether women in higher need for counseling were more likely than women in lower need to have received counseling.

METHODS

Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS), a state-specific, population-based, random sample of postpartum women, was performed by using data from 14 states for births during 1997 or 1998, for a total of 24,620 participants. Outcome measures included report of preventive health counseling during prenatal visits by specific topic as well as behaviors and experiences about cigarette use, alcohol use, breast-feeding, partner violence, and preterm labor.

RESULTS

The percentage of women that report preventive counseling during prenatal care is relatively high (> or =75%) for 9 of 13 topics. However, the percentage of women that report counseling is relatively low (<75%) for partner violence, seat belt use, illegal drug use, and human immunodeficiency virus (HIV) risk. Except for counseling about cigarette and alcohol use, women in higher need, compared with women in lower need, for three other health topics were not significantly more likely to receive counseling.

CONCLUSIONS

Preventive health counseling for partner violence, seat-belt use, illegal drug use, and risk of HIV could be increased across prenatal settings. Counseling should involve assessment of risks, with focused counseling related to those risks.