184204 Start up and incremental practice expenses for implementing behavior change interventions in primary care

Tuesday, October 28, 2008: 5:24 PM

Martey Dodoo, PhD , The Robert Graham Center for Policy Studies in Family Medicine and Primary Care, American Academy of Family Physicians, Washington, DC
Alex H. Krist, MD, MPH , Virginia Commonwealth University, Department of Family Medicine, Fairfax, VA
Maribel Cifuentes, RN, BSN , Department of Family Medicine, Aurora, CO
Larry Green, MD , Department of Family Medicine, Autora, CO
Context: If behavior change services are to be offered routinely in primary care practices, providers must be appropriately compensated. Estimating what is spent by practices in providing such services is a critical prerequisite for establishing appropriate payment, , and is the objective of this study. There is very little published on such estimates in the U.S.

Objective: To obtain credible estimates of the start-up and incremental expenses required to plan and implement each of ten behavior change interventions targeting: lack of physical activity; unhealthy diet; tobacco use; and risky use of alcohol, in primary care practices.

Methods/Outcome measures: In-practice expenditure data were collected from each of 30 practices nested in 10 PBRN interventional studies across the U.S. during 2006/2007 using a standardized instrument. The data were analyzed and credible expense estimates were calculated for the startup period, and incremental estimates for the implementation phase of the interventions.

Results: Average startup expenses were $1860 per practice (s.e. = $455). Most startup expenditures were for staff training. Average monthly direct care intervention expenditures were $15 per patient participant (s.e. = $5). Average monthly overhead intervention expenditures were $43 per patient participant (s.e. = $17). Most intervention expenditures were under-estimates, and spent on recruitment and screening.

Conclusions: Primary care practices must spend money to address their patients' unhealthy behaviors, at least $1860 to initiate systematic approaches and $58 per participant/month to implement them routinely. Until primary care payment systems incorporate these expenses, it is unlikely these services will be readily available.

Learning Objectives:
At the end of this session, participants will: 1. Learn how much primary care practices must spend to address their patientsí unhealthy behaviors routinely. 2. Providers will learn whether they can plan, prepare, adopt, implement or deliver behavior change services in their primary care practices. 3. Payers will learn whether they can pay providers to deliver behavior change services in primary care practices.

Keywords: Economic Analysis, Behavior Modification

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: MA, Ph.D. (Demography/Economics) University of Pennsylvania, Philadelphia, June, 1985
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.