Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system
Objective Exercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician a...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-02-01
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| Series: | Family Medicine and Community Health |
| Online Access: | https://fmch.bmj.com/content/12/1/e002608.full |
| _version_ | 1797222489479184384 |
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| author | Sarah E Linke John Kevin Ong Dayao Caroline E L Duffy Amalia M Cristiano Gene 'Rusty' Kallenberg |
| author_facet | Sarah E Linke John Kevin Ong Dayao Caroline E L Duffy Amalia M Cristiano Gene 'Rusty' Kallenberg |
| author_sort | Sarah E Linke |
| collection | DOAJ |
| description | Objective Exercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician and healthcare staff perspectives using a combination of electronic health record (EHR), survey and interview data.Design This study used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM. Data captured from the EHR, including Physical Activity Vital Sign (PAVS) scores, and data collected from qualitative surveys and interviews were used to evaluate the programme’s Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM, which is embedded within PRISM) from provider, staff and patient perspectives.Setting Five primary care clinics within a large academic health system.Participants A total of 24 443 patients from all participating clinics had at least one PAVS score during the study period. A total of 17 clinicians completed surveys, and 4 clinicians, 8 medical assistants and 9 patients completed interviews.Results Implementation fidelity metrics varied widely between components and across clinics but were generally consistent over time, indicating a high degree of programme maintenance. Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual. Mean PAVS scores increased from 57.7 (95% CI: 56 to 59.4) to 95.2 (95% CI: 91.6 to 98.8) min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84 (95% CI: 252 to 255.7) to 208.3 (95% CI: 204.2 to 212.4) min per week at 6 months for patients meeting PA guidelines at baseline. After EIM implementation, clinician-estimated time spent discussing PA with patients increased for 35% of providers and stayed the same for 53%.Conclusion Overall, this study established EIM’s feasibility, adoption, implementation and maintenance in routine primary care practice within a large academic health system. From a population health perspective, EIM is a model to emulate to help primary care providers efficiently address healthy lifestyle behaviours in routine primary care visits. |
| first_indexed | 2024-03-08T07:37:44Z |
| format | Article |
| id | doaj.art-017dc4e869df4074ae359003355edb73 |
| institution | Directory Open Access Journal |
| issn | 2305-6983 2009-8774 |
| language | English |
| last_indexed | 2024-04-24T13:22:09Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Family Medicine and Community Health |
| spelling | doaj.art-017dc4e869df4074ae359003355edb732024-04-04T12:25:09ZengBMJ Publishing GroupFamily Medicine and Community Health2305-69832009-87742024-02-0112110.1136/fmch-2023-002608Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health systemSarah E Linke0John Kevin Ong Dayao1Caroline E L Duffy2Amalia M Cristiano3Gene 'Rusty' Kallenberg4Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, USAUniversity of California San Diego School of Medicine, La Jolla, California, USAMilken Institute of Public Health, The George Washington University, Washington, District of Columbia, USAHerbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, USADepartment of Family Medicine, University of California San Diego, La Jolla, California, USAObjective Exercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician and healthcare staff perspectives using a combination of electronic health record (EHR), survey and interview data.Design This study used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM. Data captured from the EHR, including Physical Activity Vital Sign (PAVS) scores, and data collected from qualitative surveys and interviews were used to evaluate the programme’s Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM, which is embedded within PRISM) from provider, staff and patient perspectives.Setting Five primary care clinics within a large academic health system.Participants A total of 24 443 patients from all participating clinics had at least one PAVS score during the study period. A total of 17 clinicians completed surveys, and 4 clinicians, 8 medical assistants and 9 patients completed interviews.Results Implementation fidelity metrics varied widely between components and across clinics but were generally consistent over time, indicating a high degree of programme maintenance. Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual. Mean PAVS scores increased from 57.7 (95% CI: 56 to 59.4) to 95.2 (95% CI: 91.6 to 98.8) min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84 (95% CI: 252 to 255.7) to 208.3 (95% CI: 204.2 to 212.4) min per week at 6 months for patients meeting PA guidelines at baseline. After EIM implementation, clinician-estimated time spent discussing PA with patients increased for 35% of providers and stayed the same for 53%.Conclusion Overall, this study established EIM’s feasibility, adoption, implementation and maintenance in routine primary care practice within a large academic health system. From a population health perspective, EIM is a model to emulate to help primary care providers efficiently address healthy lifestyle behaviours in routine primary care visits.https://fmch.bmj.com/content/12/1/e002608.full |
| spellingShingle | Sarah E Linke John Kevin Ong Dayao Caroline E L Duffy Amalia M Cristiano Gene 'Rusty' Kallenberg Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system Family Medicine and Community Health |
| title | Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system |
| title_full | Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system |
| title_fullStr | Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system |
| title_full_unstemmed | Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system |
| title_short | Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system |
| title_sort | implementation and evaluation of exercise is medicine in primary care clinics within a large academic health system |
| url | https://fmch.bmj.com/content/12/1/e002608.full |
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