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Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
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2019 (English)In: HEALTH SERVICES RESEARCH AND MANAGERIAL EPIDEMIOLOGY, ISSN 2333-3928, Vol. 6, article id UNSP 2333392819862122Article in journal (Refereed) Published
Abstract [en]

Introduction: The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. Methods: Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. Results: Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. Conclusions: Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC , 2019. Vol. 6, article id UNSP 2333392819862122
Keywords [en]
primary prevention, health-care guidelines, behavioral counseling, hospital administrators
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-162329DOI: 10.1177/2333392819862122ISI: 000477857600001PubMedID: 31384624OAI: oai:DiVA.org:umu-162329DiVA, id: diva2:1343395
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-22Bibliographically approved

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Johansson, HeleneJerdén, LarsWeinehall, Lars
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