Implementing Physical Activity Screening and Referral in Primary Care - Exercise is Medicine® [Podcast Series]

• [:55] Dr. Bantham introduces her guest, Dr. Sarah Linke

  • Dr. Linke is Associate Clinical Professor and Interim Assistant Dean for Community Partnerships within the Herbert Wertheim School of Public Health and Human Longevity Science (HWSPH) and Family Medicine at UC San Diego.

  • She has a Career Development Award from the Agency for Healthcare Research & Quality (AHRQ) to implement and evaluate the Exercise is Medicine (EIM) program at UC San Diego Health.

• [1:28] Exercise as a prevention tool

  • “I had some really great training in using exercise as a treatment or even sometimes as a prevention tool, having these randomized controlled trials using exercise to treat a variety of conditions. But I was still feeling a little dissatisfied with the lack of kind of a global outlook on this, and how do we reach everyone, how do we make exercise part of everybody's life to use as a prevention tool? Why, why does it have to be that you have to have had a health problem, a health scare, to be told about this?”

• [6:19] Training physicians in motivational interviewing

  • “[A] lot of it is trying to train the physicians how to use motivational interviewing and how to do brief conversations with the patients that they're seeing about exercise.  Asking them questions, not using such a directive approach that they're often trained to do in medical school.  And really engaging the patients and helping them to lead themselves to the solution that they want to exercise because it's a, an empowering choice for them to make for their own health, not because their doctor told them they needed to do that.” 

• [11:34] Training physicians in framing exercise as relevant

  • “A lot of times we get stuck in healthcare talking to [patients] about how they can prevent cardiovascular disease in 30 years. Well, that's not relevant to them today. There's always tomorrow to exercise to prevent that from happening in 30 years. But how do we focus, how do we train them to focus on those immediate rewards that they can get? Which would be more energy, improved mood, decreased anxiety, decreased stress, all of these things that happen immediately, that would keep people exercising, and then in the long run would also prevent disease.”

• [16:26] Warm handoff to health coaches

  • “And so one of those things is asking patients in the PAVS—embedded in the PAVS—is, would you like to speak with a health coach about exercise? If they say yes, automatically—the physician doesn't even have to sign an order, nothing has to happen—we automatically get a referral for that patient. And now it's in our health coaches’ hands.”

• [21:05] Addressing the trust gap with community-based health & fitness professionals

  • “And that is definitely something, I know that that ACSM and EIM continue to talk about is that missing link of referring people out to community fitness professionals who can really take that next step with, with patients and that, that barrier has been known for a long time and no one's really solved it.  And I think that you’re identifying one of the main reasons why, in addition to, again, reimbursement, that I think that trust is crucial.”

• [22:40] Implementation science

  • “So really looking at those measures that are sustainable, as well, so that we can continue to evaluate it and adapt it along the way. So it's really a long term practice of making an intervention stick within any given setting.”

• [25:42] Providing the best patient care

  • “That's definitely been a challenge of mine is to make sure that they realize that is my ultimate goal as well. It's our shared ultimate goal. It's not to gather the best data or do the best research so that we have the best paper, but it's really to provide the best patient care to patients.”

• [27:42] Technology as a facilitator for physician exercise referrals 

  • “So we're really building systems in our, in our EMR to reduce clicks, reduce burden, in that way, allowing our providers to—we always talk about them practicing at the top of their license—to be able to spend their time focusing on this discussions rather than all of the documentation that goes along with it.”