Health Care Facility-based Settings

Health care facility-based interventions often entail heart disease and stroke counseling by a health care provider in public or private health care settings (e.g., doctor’s office, hospital, health department, assisted living facility). Counseling sessions may require education and training of providers as well as reminders or prompts for the provider to discuss heart disease and stroke and related risk factors or health conditions with their patients or clients. Likewise, interventions in health care facility-based settings may include institutional policy or environmental changes to influence provider behavior or to increase access to health services among individuals. Referrals to other community resources can also be an important part of interventions in health care settings.

Health care facility-based interventions are most effective when links to interventions in other settings are established:

  • Community-based settings (e.g., involve trained health care providers in efforts to educate policy- and decision-makers or to advocate for policy changes)
  • School-based settings (e.g., provide education and training to school nurses on current rates, risk factors, and treatment approaches for heart disease and stroke)
  • Worksite-based settings (e.g., make nutritious foods and facilities for physical activity available for employees in health care settings and enforce smoke-free workplace policies)
  • Faith-based settings (e.g., offer education and training to lay health workers in faith-based networks to increase community outreach and access to information about heart disease and stroke)
  • Home-based settings (e.g., encourage families to visit their health care provider regularly)

Previous work in health care facility-based settings has found:

  • Visual media placed in health care facility-based settings may help remind individuals to ask their health care providers about heart disease and stroke or help providers remember to speak with individuals about heart disease and stroke concerns (e.g., high blood pressure, high cholesterol).
  • Health care facility-based settings (e.g., hospitals, pharmacies, dental clinics, WIC clinics, emergency rooms, residential care facilities, pediatrician clinics) are useful for heart disease and stroke education interventions because of the natural provider-patient exchange.
  • Health care facilities often provide direct access to the individuals with or at risk for heart disease and stroke.
  • Individuals experiencing heart disease and stroke may be more motivated to make changes to lifestyle behaviors while in the care of health care facilities.  It is important to capitalize on teachable moments.
  • Because organizations in health care facility-based settings assess and store information on individuals, they are well-suited for heart disease and stroke interventions because individual information is already collected and communication systems are already in place. These settings make it easier to distribute individually-tailored information to participants.
  • Health care providers typically provide primary care to patients with heart disease.  Implementing secondary prevention measures in primary care settings to a large number of individuals can be daunting. Nurse-run clinics within general practices are practical and effective ways to increase secondary prevention of heart disease and stroke.
  • Pharmacists see a wide range of patients and have access to their medication histories though computerized databases. They are in an excellent position to recognize patients at high risk for heart disease and stroke. In collaboration with health care providers, pharmacies can provide services to help improve risk management.
  • Primary care practices and health centers are considered by many to be authoritative sources of health care and advice.
  • Health care providers can be important sources of information, motivation and support.
  • Because heath care facilities may serve a wide audience, health care providers and educators should take care to provide culturally relevant information at appropriate literacy levels.
  • The provision of caregiver counseling and education can improve quality of life for both the caregiver and patient through enhancing problem solving and communication skills, affective involvement and family function.
  • The implementation and utilization of electronic medical record systems with risk management tools in health care based settings provide an opportunity to positively reinforce physician behavior and enhance quality of care.
  • Some of the challenges in the health care setting include the limited time health care providers may have to visit with individuals and the risk of information overload because of competing or related health priorities.

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