A white paper brief action planning
Obesity Damara Gutnick, MD, Kathy Reims, MD, Connie Davis, MN, ARNP, Heather Gainforth, PhD, Melanie Jay, MD, MS, and Steven Cole, MD From the New York University School of Medicine, New York, NY Drs. Gutnick and JayUniversity of Colorado Health Sciences Center, Denver, See more Aa. ReimsUniversity of British Columbia, BC, Canada Dr. DavisUniversity College London, London, UK Dr.
Gainforthand Stonybrook University School of Medicine, Stonybrook, NY Dr. To describe Brief Action Planning A white paper brief action planning structured, stepped-care self-management support technique for chronic illness care and disease prevention. A review of the theory and research supporting BAP and the questions and skills that comprise the technique with provision of a clinical example. BAP facilitates goal setting and action planning to build self-efficacy for behavior change.
It is grounded in the principles and practice of Motivational Interviewing and evidence-based constructs from the behavior change literature. Comprised of a series of 3 questions and 5 skills, BAP can be implemented by medical teams to help meet the self-management support objectives of the Patient-Centered Medical Home. BAP is a useful self-management support technique for busy medical practices to a white paper brief action planning health behavior change and build patient self-efficacy for improved long-term clinical outcomes in chronic illness care and disease prevention.
Chronic disease is prevalent and time consuming, challenging, and expensive to manage . Given the health and financial impact of chronic disease, and recognizing that patients make daily decisions that affect disease control, efforts are needed to assist and empower patients to actively self-manage health behaviors that influence chronic illness outcomes. Patients who are supported to actively self-manage their own chronic illnesses have fewer symptoms, improved quality of life, and lower use of health care resources .
Many times, patients want to make changes that will improve their health but need support—commonly known as self-management support—to be successful.
Many times patients return to the next visit with clear ideas about changes that would be important for them to make. Building self-efficacy, which may lead to additional action planning around health, is more important [4,46]. The relationship between physician empathy and disease complications: BAP can also be used between scheduled visits.
Involving plznning in decision making, emphasizing problem solving, setting goals, creating action plans ie, when, where and how to enact a goal-directed action planning following up on goals are key features of successful self-management support methods [3,6—8]. However, the practicalities of these approaches in clinical settings have been papeg.
Finally, while chronic disease self-management programs have been shown to be effective when used by peers in the community , similar results in primary care are not well established. Given the challenges of paperr practicing, learning, and using each of these approaches, white paper to develop an approach here supports patients to make behavioral changes that can be implemented in typical practice settings are needed.
In acknowledgement of these evolving practice realities, the National Committee for Quality Assurance NCQA included development and documentation of patient self-management plans and goals as a critical factor for achieving NCQA Patient-Centered Medical Home PCMH recognition . Successful PCMH transformation therefore entails clinical practices developing effective and time efficient ways to incorporate self-management support strategies, a new service for many, into their care delivery systems often without additional staffing.
In this paper, we describe an evidence-informed, efficient self-management support technique called Brief Action Planning BAP [21—24]. BAP evolved into its current form through ongoing collaborative efforts of 4 of the authors SC, DG, CD, KR and is based on a foundation of original work by Steven Cole with contributions from Mary Cole in . This technique addresses many of the barriers providers have cited to providing self-management support, as it can be used routinely by both individual providers and health care teams to facilitate patient-centered goal setting and action planning.
BAP integrates principles and practice of MI more info goal setting and action planning concepts from the self-management support, self-efficacy, and behavior change literature.
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In addition to wite the principles and theory that inform BAP, we introduce the steps of BAP and discuss practical considerations for incorporating BAP into clinical practice. In particular, acfion include suggestions a white paper brief action planning how BAP can be used in team-based clinical practice settings within the PCMH. Finally, we present a common clinical scenario to demonstrate BAP and provide resource links to online videos of BAP encounters.
BAP is a highly structured, stepped-care, self-management support technique. Composed of a series of 3 questions and 5 skills reviewed in detail belowBAP can be used to facilitate goal setting and action planning to build self-efficacy in a white paper brief action planning illness management and disease prevention [21—24]. The overall goal of BAP is to assist an individual to create an action plan for a self-management behavior that they feel confident that they can achieve. BAP is currently being used in diverse care settings including primary care, home health care, rehabilitation, mental health and public health to assist and empower patients to self-manage chronic illnesses and disabilities including diabetes, depression, spinal cord injury, arthritis, and hypertension.
BAP is also being used to assist patients to develop action plans for disease prevention. For example, the Bellevue Hospital Personalized Prevention clinic, a pilot clinic that uses a mathematical model  to help patients and providers collaboratively prioritize prevention focus and strategies, systematically utilizes BAP as its self-management support technique for patient-centered action planning. In addition, a set of guidelines designed to plwnning fidelity in BAP research has been developed .
Underlying Principles of BAP BAP is grounded in the principles and practice of MI and the psychology of behavior change. Within behavior change, we draw primarily on self-efficacy and action planning theory and research. We discuss the key concepts in detail below.
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a white paper brief action planning The Spirit of MI MI Here Compassion, Acceptance, Partnership and Evocation is an important overarching tenet for BAP. Compassionately supporting self-management with MI spirit involves a partnership with the patient rather than a prescription for change and the assurance that the clinician has the patients oaper interest always in mind Compassion . Demonstrating MI spirit throughout the change conversation is an read article foundational principle of BAP.
Action Planning and Self-Efficacy In addition to the spirit of MI, Check this out integrates 2 evidence-based constructs from the briev change literature: Action planning requires that individuals specify when, where and how to enact a goal-directed behavior eg, self-management behaviors. Given the demonstrated potential of action planning for ensuring individuals achieve their health goals, the BAP framework aspires to assist patients to create an action plan.
Several reviews of the literature have suggested a strong relationship between self-efficacy and adoption of healthy behaviors such as smoking cessation, weight control, contraception, alcohol abuse and physical activity [39—42]. Furthermore, Lorig a white paper brief action planning al demonstrated that the process of action planning itself contributes to enhanced self-efficacy .
Description of the BAP Steps The flowchart in Figure 1 presents an overview of the key elements of BAP. An a white paper brief action planning dialogue illustrating the steps of BAP can be found in Figure 2. Three questions and 3 of read more BAP skills ie, SMART plan, eliciting a commitment statement, and lpanning are applied during every BAP interaction, while 2 skills ie, behavioral menu and problem solving for low confidence are used as needed.
The distinct functions and the evidence supporting the 3 questions and brier BAP skills are described below. Eliciting a Behavioral Focus or Goal Once engagement has been established and the clinician determines the patient is ready for self-management planning to occur, the first question of BAP can be asked: The powerful link between consistency of word and action facilitates development and commitment to change the behavior paer focus .
For these patients, clinicians can proceed directly to Skill 2—SMART Behavioral Planning; that is, asking patients directly if they are ready to turn their idea into a concrete plan. Another group of patients may want or need suggestions before committing to something specific they want to work on. For these patients, clinicians should use the opportunity to offer a Behavioral Menu Skill 1. A third group of patients may not be interested or ready to make a change at this time or at all.
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Some in this group may be healthy or already self-managing effectively and have no need to make a plan, in which case the clinician acknowledges their actikn self-management and moves to the next part of the visit. Others in this group may have considerable ambivalence about change or face complex situations where other priorities take precedence.
Would it be OK if I ask you about this again at our next visit? Other patients may benefit from additional motivational approaches to further explore change and ambivalence. If the clinician does not have these skills, patients may be seamlessly transitioned to another resource within or external to the care team. Offering a Behavioral Menu If in response to Question 1 an individual is unable to come up with an idea of their own or needs more information, then offering a Behavioral Menu may be helpful [44,45].
A behavioral menu is comprised of 2 or 3 suggestions or ideas that will ideally trigger individuals to discover an idea of their own. There are 3 distinct evidence-based steps to follow when presenting a Behavioral Menu. Asking permission to ;aper ideas respects patient autonomy and prevents the provider from inadvertently assuming an expert role.
It helps to mention things that brjef patients have decided to do with some success. Using this approach avoids the clinician assuming too much about the patient or allowing the patient to reject the ideas. It is important to remember that the list is to prompt ideas, not to find a perfect read more . Evocation from the Spirit of MI is built in with this papfr . Diagrams with equally weighted spaces assist clinicians to resist prioritizing as might happen in a list. Empty circles alongside circles containing varied options evoke patient ideas, consistent with the Spirit of MI Figure 3, Visual Behavioral Menu Example .
SMART Planning Once an individual decides on an area of focus, the clinician partners with the patient to clarify the details and create an action plan to achieve their goal. Commitment predicts subsequent behavior change, and the strength of the commitment language is the strongest predictor of success on an action plan [43,52,53].
Scaling for Confidence After a commitment statement has been elicited, the second question of BAP is asked. Not at all sure, somewhat sure, or very sure? Problem Solving for Low Confidence When confidence whkte relatively low ie, below 7we suggest action planning problem solving as the next step [8,51]. Low confidence or self-efficacy for plan completion is a concern since low self-efficacy predicts non-completion . Successfully implementing the action plan, no matter how small, increases confidence and self-efficacy for engaging in the behavior .
There are several steps that a clinician follows when collaboratively problem-solving with a patient with low confidence Figure 1. A Behavioral Menu can be offered if needed. For example, a clinician might say something like: A 5 is a lot higher than a 1.
People are more likely to have success with their action plans when confidence levels are 7 or more. Do you have any ideas of how you might be able to increase your level confidence to a 7 or more? Perhaps one of these ideas seems like paprr good one for you or maybe you have another idea?
Arranging Accountability Once the details of the plan have been determined and confidence level for success is high, the next step is to ask Question 3: Research supports that people are a white paper brief action planning likely to follow through with a plan if they choose to report back their progress  and suggests that checking-in frequently earlier in the process is helpful .
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Ideally the clinician and patient should agree on a time to check in a white paper brief action planning the plan within a week or two Figure 2, entry The patient may also choose to be accountable to themselves by using a calendar breif a goal setting application link their smart phone device or computer. Follow-up Follow-up has been noted as one of the features of successful multifactorial self-management interventions and builds trust .
Follow-up with the care team includes a discussion of how the plan went, reassurance, and next steps Figure 4. Checking-in encourages reflection on challenges and barriers as well as successes. Patients should be given guidance to think through what worked for them and what did not. If follow-up is not done with the care team in the near term, brieg can be accomplished at the next scheduled visit. Patient portals provide another opportunity for patients to dialogue a white paper brief action planning the care team about their plan.
Br J Gen Pract ; Psychol Addict Behav ; J Clin Outcomes Manag ; Chronic disease self-management program: People are more likely to have success with their action plans when confidence levels are 7 or more. Their whute and costs. Underlying Principles of BAP BAP is grounded in the principles and practice of MI and the psychology of behavior change. Comprised of a series of 3 questions and 5 skills, BAP a white paper brief action planning be implemented by medical teams to help meet the self-management support objectives of the Patient-Centered Medical Home.
Another caveat to consider is that the process of planning is more important that the actual plan itself. It is imperative to allow the patient, not the clinician, to determine the plan.