1. Emerging Lessons of Achieving Health Behavior Change in Primary Care Patients 2005 National Conference on Tobacco or Health

2. Presenters Helen Roemhild, MEd, CCRA Pamela Werb, MEd, CCRC, CCRA Maribel Cifuentes, RN Kevin Peterson, MD, MPH Tai Mendenhall, PhD, LMFT

3. Minnesota Physicians Motivating Health Improvement: The MINIT Study University of Minnesota Medical School Department of Family Medicine and Community Health

4. Research Team Kevin Peterson Principal Investigator Sharon Allen Co-Investigator Tai Mendenhall Co-Investigator Helen Roemhild Technical Assistance Pam Werb Technical Assistance Mark Janowiec Computer Programmer Richard Botehlo Consultant

5. Background Funded by the Robert Wood Johnson Prescription for Health Initiative Utilized Minnesota Academy of Family Physicians Research Network (MAFPRN) for clinic recruitment

7. Minnesota Academy of Family Physicians Research Network (MAFPRN)

8. MINIT Study Clinic Sites & Local Investigators Parkview Medical Clinic (New Prague) –Dan Berg, MD Park Nicollet Clinic (Minnetonka) –Don Pine, MD Soteria Family Health Center (Plymouth) –Ruth Bolton, MD Phalen Village Clinic (St. Paul) –George Smith, MD Fairview – Eden Center Clinic (Eden Prairie) –David Johnson, MD

9. MINIT Study Clinic Sites & Local Investigators (con’t) Family Practice Medical Center (Willmar) –Mary Amon, MD Creekside Family Physicians (St. Louis Park) –Shannon Neale, MD Payne Avenue Medical Clinic (St. Paul) –Sharon Allen, MD, Phd CentraCare Clinic (Long Prairie) –Paul Van Gorp, MD Starbuck Clinic (Starbuck) –Stacy Luetmer, MD

10. MINIT Study Sites Minnesota

11. Community Partners Blue Cross Blue Shield of Minnesota Hazelden Foundation Park Nicollet Foundation Be Active Minnesota Minnesota Partnership for Action Against Tobacco HealthPartners, Inc. National Diabetes Education Program

12. Objective The aim of this pilot study was to assess subject recruitment issues including: Number screened vs. number enrolled Subject intervention mode preference Stages of change movement (as determined by a specific process measure tool at baseline, 30 and 180 days) Subject engagement in intervention Subject engagement in intervention

13. Study Goals Determine the feasibility of a program to address unhealthy behaviors in primary care patients who are not currently considering behavior change Target smoking, risky drinking, unhealthy eating (obesity), sedentary lifestyle

14. Design 10 Primary Care Clinics 18 Patients per clinic Recruited patients scheduled for periodic health exams or non-acute visits Standardized screening tools Electronic real time enrollment

15. Screening Questions Do you smoke 10 cigarettes or more per day? Body Mass Index (BMI) ≥ 25 Do you exercise three or more times, or get 180 minutes or more of moderate exercise (such as walking) per week? 5 Shot questionnaire for risky drinking

16. Consent and Study Process Obtained consent Provider delivered motivational message Scored for readiness to change Intervention selection –Self help study guide –Telephone intervention with motivational coach and self help study guide –Interactive computer intervention with motivational coach and online self help study guide

17. Online Intake Survey

18. Follow-up Survey

19. Results: Demographics Total eligible for enrollment (n = 114) Male 30% (n = 34) Female 70% (n = 80) Ethnicity Caucasian 73%(n = 83) Native American 2%(n = 03) African American 1%(n = 01) Non-responders24%(n = 27) Ages 18 – 29 6%(n = 5) 30 – 39 17%(n = 15) 40 – 49 25% (n = 22) 50 – 64 35% (n = 40) 65+ 11% (n = 10) 65+ 11% (n = 10)

20. Results: Study Enrollment Smoking Eating Exercise Alcohol 8241011147 61514 020 Self Help Telephone Computer

21. Results: Subject Recruitment and Intervention Preference Number of patients screened (n = 152) Number of patients enrolled (n = 120) Intervention Preference 39% Smoking 31% Poor Diet 31% Exercise 1% Risky Drinking 1% Risky Drinking

22. Results: Study Attrition 30 Day Follow-up telephone (7%) telephone (7%) self-help (19%) self-help (19%) computer (45%) computer (45%) 180 Day Follow-up 180 Day Follow-up telephone (4%) telephone (4%) self-help (18%) computer (41%)

23. Results: Readiness to Change 30 Day follow-up Percent of subjects moving from Percent of subjects moving from precontemplative to contemplative or contemplative to planning stage 55% Smoking (n = 31) 83% Poor Diet (n = 20) 77% Exercise (n = 22)

24. Results: Readiness to Change 180 Day Follow-up Percent of subjects changing from precontemplative to contemplative or contemplative to planning stage Percent of subjects changing from precontemplative to contemplative or contemplative to planning stage 100%Smoking (n = 42) 100%Poor Diet (n = 32) 100% Exercise(n = 35)

25. Summary Patient preference for intervention Attrition Screening protocol Electronic real time enrollment

26. Contact Information Kevin Peterson, MD MPH University of Minnesota Medical School Department of Family Medicine and Community Health 925 Delaware Street SE, Suite 220 Minneapolis, MN 55414 Email: peter223@umn.edu