Primary Care Providers' Perspective on the Inclusion of Behavioral Risk Measures in the Electronic Health Record for Patient Engagement of Individuals with Multiple Chronic Conditions

Abstract

The Society of Behavioral Medicine issued a policy statement supporting inclusion of a "core set of behavioral and psychosocial measures in EHRs" in 2011. The core set of 17 screening measures cover nine domains: anxiety and depression, eating patterns, physical activity, quality of life, risky drinking, sleep quality, stress, substance use, and tobacco use. Addressing modifiable risk behaviors may facilitate positive health outcomes for individuals with multimorbidities; and, since care coordination for most patients with multimorbidities as well as assessment and counseling for modifiable risk behaviors occur in the primary care setting, primary care appears to be the most appropriate location to collect and use risk behavior information. However, primary care settings are currently under-resourced and lack sufficient time for additional initiatives. The aim of this study is to illuminate, through qualitative research methods, primary care providers' perspective to the Society of Behavioral Medicine's recommendation of including risk behaviors into the electronic health record (EHR). A secondary aim was to learn how information about these risk behaviors within an EHR might effectively be utilized within a primary care setting. Primary care providers acknowledge the importance of risk behaviors in general, and support many of the specific questions that is recommended though they counsel against mandating the inclusion of these risk behaviors into the EHR at this time based on five themes that emerged from this analysis: constriction on providers' time, importance of risk behavior information, balancing disease management with the patient's illness narrative, technology's contribution to care, and regulatory perspective.