Brief Action Planning to Facilitate Behavior Change and Support Patient Self-Management

Finally, BAP can be completed over multiple visits. For patients who are thinking about change but are not yet committed to planning, a brief suggestion about the value of action planning with a behavioral menu may encourage additional self-reflection. Many times patients return to the next visit with clear ideas about changes that would be important for them to make.

Fitting BAP into a 20-Minute Visit

Using BAP is a time-efficient way to provide self-management support within the context of a 20-minute visit with engaged patients who are ready to set goals for health. With practice, clinicians can often conduct all the steps within 3 to 5 minutes. However, patients and clinicians often have competing demands and agendas and may not feel that they have time to conduct all the steps. Thus, utilizing other members of the health care team to deliver some or all of BAP can facilitate implementation.

Teams have been creative in their approach to BAP implementation but 2 common models involve a multidisciplinary approach to BAP. In one model, the clinician assesses the patient readiness to make a specific action plan by asking Question 1, usually after the current status of key problems have been addressed and discussions begin about the interim plan of care. If the patient indicates interest, another staff member trained in BAP, such as an medical assistant, health coach or nurse, guides the development of the specific plan, completes the remaining steps and inputs the patient’s BAP into the care plan.

In another commonly deployed model, the front desk clerk or medical assistant helps to get the patient thinking by asking Question 1 and perhaps by providing a behavioral menu. When the clinician sees the patient, he follows up on the behavior change the patient has chosen and affirms the choice. Clinicians often flex seamlessly with other team members to complete the action plan depending on the schedule and current patient flow.

Regardless of how the workflows are designed, BAP implementation requires staff that can provide BAP with fidelity, effective communication among team members involved in the process and a standardized approach to documentation of the specific action plan, plan for check-in and notes about follow-up. Care teams commonly test different variations of personnel and workflows to find what works best for their particular practice.

Implementing BAP to Support PCMH Transformation

To support PCMH transformation substantial changes are needed to make care more proactive, more patient-centered and more accountable. One of the common elements for PCMH recognition regardless of sponsor is to enhance self-management support [20,57,58]. Practices pursuing PCMH designation are searching for effective evidence-based approaches to provide self-management support and guide action planning for patients. The authors suggest implementation of BAP as a potential strategy to enhance self-management support. In addition to facilitating meeting the actual PCMH criteria, BAP is aligned with the transitions in care delivery that are an important part of the transformation including reliance on team-based care and meaningful engagement of patients in their care [59,60].

In our experience, BAP is introduced incrementally into a practice initially focusing on one or two patient segments and then including more as resources allow. Successful BAP implementation begins with an organizational commitment to self-management support, decisions about which populations would benefit most from self-management support and BAP, training of key staff and clearly defined workflows that ensure reliable BAP provision.