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Member Research & Reports

Member Research & Reports

Iowa Dean Assesses Integrating Behavioral Counseling into Primary Care

Preventable conditions resulting from behavioral risk factors such as tobacco and alcohol consumption, poor diet, and low physical activity contribute substantially to premature morbidity and mortality in the United States. Integrating behavioral counseling interventions (BCIs) into the primary care setting has the potential to significantly reduce this burden. A special August supplement to the American Journal of Preventive Medicine, funded by the Agency for Healthcare Research and Quality (AHRQ), addresses the need for further integration of BCIs into primary care and the challenges in achieving this goal.

The August Special Supplement came about as a result of an Expert Forum convened in November 2013 by the U.S. Preventive Services Task Force (USPSTF) to support its efforts to develop BCI recommendations. The USPSTF is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Forum brought together experienced behavioral counseling researchers; senior leaders of the National Institutes of Health (NIH) and Centers for Disease Control (CDC); USPSTF members; and senior members of the AHRQ team supporting the USPSTF, to develop actionable recommendations both to enhance USPSTF methods related to BCI recommendations and to broaden the evidence base for these recommendations.

The Special Issue, titled Evidence-Based Behavioral Counseling Interventions as Clinical Preventive Services:  Perspectives of Researchers, Funders, and Guideline Developers, reports and expands on discussions from the Forum and provides actionable recommendations for researchers, guideline developers, and funders.

According to an introductory editorial by guest editors Dean Susan J. Curry, University of Iowa College of Public Health, and Mr. Robert McNellis, senior advisor for primary care, Agency for Healthcare Research and Quality, “BCIs have the potential to relieve a significant portion of the health burdens that afflict people, families, and communities in the U.S. Together, the perspectives presented in this journal supplement provide important guidance for researchers, funders, and professional societies to address research gaps and better coordinate their activities to fulfill this potential.”

The first four papers of the supplement present perspectives from Forum attendees. In the first article, former USPSTF member and guest editor Dean Curry, and her co-author, Dr. Evelyn Whitlock, introduce readers to the USPSTF’s methods for developing BCI recommendations and ways in which the evidence around these interventions often falls short. The following three papers delve more deeply into the challenges around meeting the USPSTF’s standards of evidence for BCIs and provide recommendations for researchers, funders, and guideline makers to enhance the quality of the evidence generated and report on the evidence required for positive recommendations.

Addressing the challenges identified during the Expert Forum requires coordination between not only the research community and USPSTF, but also Federal partners and other guideline-making bodies. In three articles, representatives from AHRQ, NIH, the Community Preventive Services Task Force, and the Society of Behavioral Medicine describe current processes for aligning efforts between their organizations and the USPSTF as well as the challenges in coordinating across disciplines.

The remaining articles of the special issue provide lessons learned from lead investigators of three studies included in evidence reviews for recently published USPSTF behavioral counseling recommendations. The authors describe the design and implementation of their studies and provide suggestions to fellow researchers to increase the likelihood of studies being included in USPSTF evidence reviews.

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