Office system interventions supporting primary care-based health behavior change counseling

Content: This article reviews the literature on the effectiveness of office system interventions to improve behavior-change counseling in primary care . These instructions consist of two principle components: tools and teamwor k. Tools have been developed to assist providers with health risk assessmen t (questionnaires, health risk appraisals), prompting and reminding (chart stickers, checklists, flow charts, reminder letters), and education (manual s and handbooks). Teamwork entails the coordination and delegation of tasks between providers and staff. Conclusions: A number of clinical trials, particularly in the area of smoki ng cessation, have demonstrated the effectiveness of tools and teamwork for increasing counseling rates and counseling effectiveness. Although no one type of tool or method of teamwork is consistently more effective than anot her-with effectiveness varying according to practice, provider, and patient characteristics-the use of different tools and teamwork approaches leads t o additive improvements in counseling and patient behavior-change rates. Mo re high-quality research is needed, particularly in the areas of health ris k assessment and electronic reminder systems, to develop effective office i nterventions that can be readily implemented into a wide variety of primary care practices.