Exercise Advisor

Exercise Counseling and Referral  Study for Primary Care conducted by Julien Dedier, MD, MPH

Summary:

Regular physical activity of moderate or greater intensity is beneficial to ameliorate or prevent a range of diseases. However, Primary Care practices are poorly equipped to provide exercise counseling due to inadequate provider training and the absence of convenient work flows for exercise counseling and referral. This study aims to evaluate an application within the electronic medical record (EMR) to assist providers to conduct exercise counseling, create an exercise prescription, and refer interested patients to use a computerized exercise coach system by telephone.

A primary study outcome is to evaluate the process of implementing this system into the Family Medicine and Adult Primary Care (GIM) practices at BMC. Attending physicians, nurse practitioners, physician’s assistants and residents who work in these clinics will provide feedback about the EMR exercise counseling and referral system. Information about their use of the system will also be tracked electronically. In addition, primary care patients who are referred to use the exercise coach and patients who call the study to ask about the exercise coach will provide feedback about the exercise counseling encounter. Results from this study will help inform how to integrate exercise promotion and referral into Primary Care practice.

Exercise Referral – The Automated Exercise Telephone Coach:

The automated telephone coaching system used in this study is called Telephone-Linked Care for Physical Activity (TLC-PA) and is designed to help adults achieve national recommendations of ≥ 30 minutes of moderate-or-greater physical activity (MOD+PA) at least 5 days/week. TLC-PA gives the user feedback on reported levels of PA, helps him/her set PA goals appropriate to the his/her readiness to do regular exercise, and gives a PA prescription for the upcoming week. The system also explores benefits and barriers to regular PA and suggests strategies to achieve PA goals tailored to the user’s cognitive-behavioral state. TLC was shown to increase levels of physical activity in NIH-funded randomized trials, and has now been adapted to cultural characteristics of urban, African-American adults in Boston.

Study Participants:

A. Patients. To be in this study, patients must meet the following criteria: (1) receive primary care in the BMC General Internal Medicine (GIM) or Family Medicine (FM) clinic; (2) be designated African-American or black in the electronic medical record (EMR); (3) be designated English-speaking in the EMR and confirmed by the treating provider; (4) be deemed able to exercise by the treating provider; (4) be aged 18 yrs or older. Patients with a diagnosis of hypertension on their active EMR problem list are considered ineligible.

B. Providers. Eligible providers are attending physicians, nurse practitioners, physician assistants and residents who practice in the BMC GIM or FM clinic.

For more information about this research study, please contact the Principal Investigator, Julien Dedier, M.D., M.P.H at 617-414-6931.