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Planning, preparation make annual wellness visits more valuable

A targeted, low-intensity intervention helped patients and clinicians improve the quality of health risk assessment-guided health conversations during annual wellness visits, according to research recently published in the Journal of the American Board of Family Medicine.

“Health risk assessments have been implemented and studied for decades in various settings, but little is known about the effect of introducing [health risk assessments] on the dynamics and content of patient-clinician conversations during Medicare Annual Wellness Visits and whether the effective use of [health risk assessments] requires additional training and resources,” Zsolt J. Nagykaldi, PhD, of the department of family and preventive medicine, University of Oklahoma Health Sciences Center, and colleagues wrote.

Researchers analyzed 40 annual wellness visits performed in an academic family medicine residency practice. At baseline, they noted that there were many opportunities missed for shared decision making and behavior change. The researchers also noted that clinicians dominated these conversations which often discussed specific clinical problems, rather than general health conversations and health care planning. Both patients and clinicians struggled with framing the annual wellness visit and how it should differ compared with other office visits.

After a 3-month baseline period, three of the physicians and their patients received an intervention. Physicians received a 30-minute web-based introduction to motivational interviewing and collaborative goal setting, a 15-minute orientation on the health risk assessment report and how it can be used for health planning, a 1-page motivational interviewing administration aid and coding support. Patients received a 5-minute orientation before the visit to help them think about their health priorities and more effectively communicate with their physician.

Nagykaldi and colleagues found that the intervention significantly decreased the proportion of clinician talk time per visit by 9% (P < .001), increased the proportion of patient talk time by 7% (P < .001), robustly increased the number and duration of “change talk” — defined as verbalization of the intent of or strategies for changing health behavior by either the patient or clinician — by 639% (P = .0007), increased the number of patient cut-ins — defined as patients interrupting a sentence uttered by the clinician without waiting for their turn — by 237% (P = .04) and tended to increase the number and duration of clinician “advice talk” — defined as providing specific and focused suggestions or recommendations without further explanation —and left patients feeling more motivated, empowered and informed.

The researchers also noted that clinicians found that the process helped them construct a more effective visit agenda and it facilitated the convergence of patient goals with evidence-based recommendations.

“Our pilot study suggests that more work needs to be done to realize the potential of [annual wellness visits] and enable patients and clinicians to maximize the value of [health risk assessment]-based health planning,” Nagykaldi and colleagues wrote. “It also suggests that simply inserting a [health risk assessment] into a patient visit may not improve shared decision making, goal setting, and unhealthy behaviors. Furthermore, the results indicate that strategically implemented, feasible interventions may significantly improve at least some aspects of health conversations between patients and clinicians.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.