Behavior modification in primary care: The pressure system model

The leading causes of death in the United States are predominantly attribut able to modifiable behaviors. Patients with behavioral risk factors for pre mature death and disability, including dietary practices; sexual practices; level of physical activity; motor vehicle use patterns; and tobacco, alcoh ol, and illicit substance use, are seen far more consistently by primary da re providers than by mental health specialists. Yet models of behavior modi fication are reported, debated, and revised almost exclusively in the psych ology literature. While the Stages of Change Model, or Transtheoretical Mod el, has won application in a broadening array of clinical settings, its app lication in the primary care setting is apparently quite limited despite ev idence of its utility [Prochaska J, Velicer W.Am J Health Promot 1997;12:38 -48]. The lack of a rigorous behavioral model developed for application in the primary care setting is an impediment to the accomplishment of public h ealth goals specified in the Healthy People objectives and in the reports o f the U.S. Preventive Services Task Force. The Pressure System Model report ed here synthesizes elements of established behavior modification theories for specific application under the constraints of the primary care setting. Use of the model in both clinical and research settings, with outcome eval uation, is encouraged as part of an effort to advance public health. (C) 20 00 American Health Foundation and Academic Press.