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A Resource from the American College of Preventive Medicine

There is little question that our daily behaviors, from lifestyle habits to self managing medical conditions, have a powerful effect on our health and quality of life. But a large gap exists between what the evidence shows that people should be doing and what they actually are doing. The statistics are daunting – a majority of Americans are overweight, inactive and not eating healthy, nearly one in four adults still smokes, many are non-compliant with their prescriptions and relatively few are doing a good job self managing their chronic disease. Until individuals are motivated to become more active participants in their own health management, the trends in escalating costs and poor health outcomes are likely to continue.

Physician advice has been consistently shown to stimulate attempts to improve health-related behaviors. But, unfortunately, advice alone seldom results in long term success. Many patients want to change, but just don’t know how. Patients who are counseled in behavior change strategies have a much greater chance of success. However, physicians face multiple barriers in providing such counseling, including lack of time, insurance disincentives, and lack of confidence in their ability to counsel and the patient’s ability to change. Consequently, few patients receive effective behavior change counseling.

This situation can be improved by several changes in office systems and provider practices. One promising development is the growth of health "coaching”. It is a simplified type of counseling that focuses strictly on developing and supporting a behavior change plan that the patient believes in. Patients with underlying psychological issues or more complex behavioral issues (e.g., addictions) require credentialed counselors or therapists. But, for many patients, a simple coach is sufficient. The advantage of coaching is that non-clinical staff can be trained to provide it, thus it serves well as a complement to physician advice.

The Coaching and Counseling Time Tool developed by the American College of Preventive Medicine is an innovative educational tool designed to assist the physician in a more systematic approach to behavior change interventions. The tool includes a practical approach for a clinical visit using an assistant in a "coach” role; it also includes a robust clinical reference document delineating behavior change strategies, guidelines and recommendations, overcoming practice barriers, office system enhancements, along with additional tools and resources, and a patient handout.

This educational activity is intended for primary care physicians.

After completing this program, physician participants should be able to:

  • Describe barriers that physicians must overcome to improve the delivery of behavior change interventions

  • Describe strategies to improve the number of patients who are coached in behavior change

  • Assess the readiness of a patient to consider a behavior change

  • Describe principles of motivational interviewing

  • Describe the 5A model for counseling on behavior change

  • Assess the practice to identify ways to enhance office systems regarding behavior change

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME). The American College of Preventive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American College of Preventive Medicine designates this Enduring Material for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The estimated time to complete this activity is 1.0 hour.

To earn CME credit for this educational activity:

  1. Read the CME information on this page.
  2. Read the Time Tool and Clinical Reference.
  3. Complete the CME post-test exam with a score of at least 70%.
  4. Complete the CME evaluation survey.
  5. Your CME certificate will be sent to you via email.


2009 through December 2011. Original release date: December 2009


These materials have been reviewed by the members of the American College of Preventive Medicine to ensure the continued scientific accuracy and medical relevance of information presented and its independence from commercial bias.

  • Mark Dal Corso, MD, MPH
    LSU School of Medicine at New Orleans
    New Orleans, LA

  • Sherry Crump, MD, MPH
    Morehouse School of Medicine
    Atlanta, GA

  • Paula Scariati, DO, MPH
    Oregon Health & Science University
    Portland, OR

In the interest of providing an educational experience free of commercial bias, and as the accredited provider of CME for this activity, the American College of Preventive Medicine was responsible for decisions regarding educational content and allocation of funds. All individuals involved in the planning, development, and delivery of educational activities are required to sign a conflict of interest statement in which they disclose any relevant financial interests or other affiliations with industry or other associations which may have direct and substantial interest in the subject matter of the CME activity. Such disclosure allows program participants to better evaluate the objectivity of the information presented in the program.

  • Mark Dal Corso, MD, MPH has disclosed no financial relationships.
  • Sherry Crump, MD, MPH has disclosed no financial relationships.
  • Paula Scariati, DO, MPH has disclosed no financial relationships.
  • Larry Mattson, Medical Writer, has disclosed no financial relationships.

These pages may be viewed using standard Internet browser applications (e.g. Internet Explorer). They may also be downloaded as PDFs and read using standard PDF reader applications (e.g. Adobe Acrobat Reader).

The American College of Preventive Medicine collects personal information from participants in this online activity for purposes of assigning CME credit only. We will not share or sell your contact information, and your answers to quizzes and feedback forms will be kept confidential.

This material is copyright of the American College of Preventive Medicine.


If you have questions regarding this CME activity, please contact cme@acpm.org.






Copyright 2009 American College of Preventive Medicine. All Rights Reserved.


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