Primary Care

Chronic Care Model linked to exercise discussions during primary care office visits for diabetes

The Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care. A new study links full implementation of this model to longer discussions about exercise during primary care visits with patients with type 2 diabetes, who must carefully control diet and exercise to control their disease. A team of San Antonio-based researchers audio-recorded 162 office visits of patients with type 2 diabetes at 20 different clinics served by 45 primary care physicians. They scored the clinics on their level of CCM implementation. They were also interested in discovering if the level of CCM implementation in primary care clinics was related to exercise stage of change (SOC). Stages of change are distinct stages individuals go through before they adopt a health behavior. Those stages are precontemplation, contemplation, preparation, action, and maintenance.

Although overall time spent counseling on exercise-related matters was statistically correlated with CCM scores, the time differential was very small. In fact, the total range of time spent in this activity was very limited across the entire group. The average time discussing exercise was 22 seconds (range, 8-36 seconds). In clinics with full implementation of CCM, discussions of exercise may be 18 to 33 seconds longer compared with those with basic implementation. These discussions took place during a visit lasting approximately 18 minutes (range, 10-26 minutes).

The patient exit survey revealed that patients who were in the contemplation, preparation, and action SOCs, were more likely to discuss exercise than those in the maintenance and precontemplation SOCs. The researchers concluded that primary care clinics with consistent CCM care and more time spent discussing exercise during a routine visit may have prepared proactive teams, resulting in better support for self-care behaviors. This study was supported by the Agency for Healthcare Research and Quality (HS13008).

See "The chronic care model and exercise discussions during primary care diabetes encounters," by Neela K. Patel, M.D., M.P.H., and Michael L. Parchman, M.D., M.P.H., in the January/February 2011 Journal of the American Board of Family Medicine 24, pp. 26-32.

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