Preventing disease through opportunistic, Rapid EngagEMent by Primary care Teams using Behaviour Change Counselling.

在西方世界，吸烟、酗酒、不健康饮食和缺乏锻炼是导致健康不良和早逝的最重要的可改变的原因。公众期望临床医生对他们的健康相关行为感兴趣，并将临床医生视为可靠的信息和建议来源。向患者提供有关健康威胁行为的简短建议是医生和护士所能做的最具成本效益的事情之一。然而，患者有时会发现这些干预措施毫无帮助，并且通常不会因此而改变。建议针对单一的危险行为，但与健康有关的行为是相互关联的：减肥涉及不同的饮食和更多的锻炼，并可能受到饮酒和吸烟的影响。动机访谈（MI），开发用于专业成瘾辅导员，是一个令人兴奋的和有效的方法，帮助患者探索和解决矛盾的变化。我们在15年的广泛发展工作中为全科医生和实习护士调整了MI，使人们参与一系列不健康行为，以早期预防疾病。其结果是一种称为行为改变咨询（BCC）的咨询方法。现在需要一个科学的评估，以确定患者是否作出有意义的变化时，看到的全科医生和实践护士在BCC培训。我们计划通过从24名全科医生中招募至少一名全科医生和一名实习护士来进行这项研究。随机选择的一半实践的临床医生将在研究开始时接受BCC培训。其余的人将提供他们的常规护理，因此作为对照组，并在研究结束时提供相同的BCC培训。参加干预和控制实践的患者将接受四种不健康行为的筛查，并由临床医生给出结果。咨询结束后，患者将被问及他们是否记得接受过有关不健康行为的干预，他们对此的感受以及他们的改变计划。将在3个月和12个月时再次评估患者的四种健康行为。将比较接受过BCC培训的临床医生与未接受BCC培训的临床医生的患者的结果。如果看到经过培训的临床医生的患者做出了更有意义的改变，我们将改进BCC，进行更大规模的研究，并向NHS提供培训。

Smoking, excessive alcohol, unhealthy eating and lack of exercise are the most important modifiable causes of ill health and early death and in the Western world. The public expect clinicians to be interested in their health related behaviours and regard clinicians as credible sources of information and advice. Brief advice to patients about health threatening behaviour is one of the most cost effective things doctors and nurses can do. However, patients sometimes find these interventions unhelpful and they do not often change as a result. Advice is given about a single risky behaviour, but health related behaviours are interlinked: losing weight involves eating differently and exercising more and may be affected by alcohol use and smoking. Motivational interviewing (MI), developed for use by specialist addiction counsellors, is an exciting and effective approach for helping patients explore and resolve ambivalence about change. We have adapted MI during 15 years of wide-ranging development work for GPs and practice nurses to engage people about a range of unhealthy behaviours for the early prevention of disease. The result is a consulting method called Behaviour Change Counselling (BCC). A scientific evaluation is now needed to determine whether or not patients make meaningful changes when seen by GPs and practices nurses trained in BCC. We plan to do this study by recruiting at least one GP and one practice nurse from each of 24 from general practices. The clinicians from half the practices selected by chance will be trained in BCC at the beginning of the study. The rest will provide their usual care and so act as a comparison group, and be offered the same BCC training at the end of the study. Patients attending both intervention and control practices will be screened for four unhealthy behaviours and clinicians given the results. After the consultations, patients will be asked if they recalled getting an intervention about unhealthy behaviours, what they felt about it, and their plans for change. Patients will be assessed for the four health behaviours again at three and twelve months. Results will be compared for those patients who saw clinicians trained in BCC with patients who saw clinicians not trained in BCC. If the patients who saw the trained clinicians make significantly more meaningful changes, we will refine BCC, do larger studies and roll out training to the NHS.