Change in the Clinical Encounter Following Research Participation
Change in the Clinical Encounter Following Research Participation
Purpose: Following anecdotal reports of unexpected patient and/or clinician behavior change in the primary care encounter in a previous study, we conducted this study to learn more about the short- and long-term effects on clinician and/or patient behavior from participation in a practice-based research network (PBRN) study.
Methods: Clinicians in two PBRN studies of Acanthosis nigricans were surveyed and interviewed 3 to 6 months following one study and surveyed 3 to 5 years following a second study. We gathered data on clinicians' reports of behavior change in the encounter, the persistence of those changes, and the likely causes of reported changes.
Results: Eighty-six percent of clinicians in the short-term and 79% in the long-term samples reported more frequent diagnostic efforts, and 68% and 54%, respectively, reported more frequent preventive counseling after participation in the studies. Interview data suggested that several factors contributed to this reported behavior change: increased clinician knowledge, availability of a feasible tool to support counseling, change in patient receptivity/motivation, and creation of a new context for counseling.
Conclusions: Reports of behavior change in the primary care encounter associated with a PBRN study suggest that PBRNs may be effective vehicles for education, translation, and practice change in addition to their value in research.
In the primary care setting, changing unhealthy behaviors in their patients is one of the most challenging tasks clinicians face. Theoretical models can guide approaches to inducing patient behavior change, but studies have shown limited success in actually changing behavior. Somewhat ironically, efforts to change physician behavior have been similarly unproductive. A large scientific literature reports the limited and often short-term effects of various strategies to modify clinician behavior, despite theoretical models guiding interventions.
With these considerations in mind, we were intrigued by anecdotal reports of behavior change occurring in primary care encounters as a result of participation in a practice-based research network (PBRN) study. In a study of the prevalence of Acanthosis Nigricans (AN, a skin condition often associated with hyperinsulinemia) and diabetes risk factors, several clinicians reported that making a diagnosis of AN resulted in changes in the dynamics of the encounter. Reportedly, more time was spent on preventive counseling than would have been the case without diagnosing AN.
A subsequent study of AN provided the opportunity to further explore reported effects of PBRN study participation on the primary care encounter—an understudied, yet potentially important aspect of PBRNs. Building on the original study in the RIOS Net PBRN, the PRIME Net consortium of PBRNs undertook a study of AN prevalence that included clinician education about AN. As part of this research, we designed a study to gather observations from clinicians about the effects of diagnosing AN on the patient encounter.
Abstract and Introduction
Abstract
Purpose: Following anecdotal reports of unexpected patient and/or clinician behavior change in the primary care encounter in a previous study, we conducted this study to learn more about the short- and long-term effects on clinician and/or patient behavior from participation in a practice-based research network (PBRN) study.
Methods: Clinicians in two PBRN studies of Acanthosis nigricans were surveyed and interviewed 3 to 6 months following one study and surveyed 3 to 5 years following a second study. We gathered data on clinicians' reports of behavior change in the encounter, the persistence of those changes, and the likely causes of reported changes.
Results: Eighty-six percent of clinicians in the short-term and 79% in the long-term samples reported more frequent diagnostic efforts, and 68% and 54%, respectively, reported more frequent preventive counseling after participation in the studies. Interview data suggested that several factors contributed to this reported behavior change: increased clinician knowledge, availability of a feasible tool to support counseling, change in patient receptivity/motivation, and creation of a new context for counseling.
Conclusions: Reports of behavior change in the primary care encounter associated with a PBRN study suggest that PBRNs may be effective vehicles for education, translation, and practice change in addition to their value in research.
Introduction
In the primary care setting, changing unhealthy behaviors in their patients is one of the most challenging tasks clinicians face. Theoretical models can guide approaches to inducing patient behavior change, but studies have shown limited success in actually changing behavior. Somewhat ironically, efforts to change physician behavior have been similarly unproductive. A large scientific literature reports the limited and often short-term effects of various strategies to modify clinician behavior, despite theoretical models guiding interventions.
With these considerations in mind, we were intrigued by anecdotal reports of behavior change occurring in primary care encounters as a result of participation in a practice-based research network (PBRN) study. In a study of the prevalence of Acanthosis Nigricans (AN, a skin condition often associated with hyperinsulinemia) and diabetes risk factors, several clinicians reported that making a diagnosis of AN resulted in changes in the dynamics of the encounter. Reportedly, more time was spent on preventive counseling than would have been the case without diagnosing AN.
A subsequent study of AN provided the opportunity to further explore reported effects of PBRN study participation on the primary care encounter—an understudied, yet potentially important aspect of PBRNs. Building on the original study in the RIOS Net PBRN, the PRIME Net consortium of PBRNs undertook a study of AN prevalence that included clinician education about AN. As part of this research, we designed a study to gather observations from clinicians about the effects of diagnosing AN on the patient encounter.
