The Community Health Educator Referral Liaison (CHERL)

Background: Tobacco use, unhealthy diet, physical inactivity, and risky alcohol use are leading causes of preventable death. As there are many barriers that prevent primary care clinicians from effectively assisting patients with these behaviors, connecting patients with health behavior resources may reduce these unhealthy behaviors. Methods: A new adjunct role in primary care practice, the community health educator referral liaison (CHERL), was tested in 15 practices in three Michigan communities. All practices were advised how to access this liaison, and nine practices were randomly selected to receive support to develop a systematic referral process. Adult patients needing improvernent in at least one of the four unhealthy behaviors were eligible for referral. The CHERL contacted referred patients by telephone; assessed health risks; provided health behavior-change counseling, referral to other resources, or both; and sent patient progress reports to referring clinicians. Data were collected from February 2006 through July 2007. Results: The CHERLs received 797 referrals over 8 months, a referral rate of 0%-2% per practice. Among referred patients, 55% enrolled, and 61% of those participated in multiple-session telephone counseling; 85% were referred to additional resources. Among patients enrolling, improvements (p < 0.001) were reported at 6 months for BMI, dietary patterns, alcohol use, tobacco use, health status, and days of limited activity in the past month. Conclusions: The results of this study suggest that through relationships with practices, patients, and community resources, these liaisons successfully facilitated patients' behavior change. The CHERL role may fill a gap in promoting healthy behaviors in primary care practices and merits further exploration.