Health promotion counseling of chronic-disease patients during primary care visits.

Abstract

OBJECTIVES. This study was designed to provide an empirical description, based on a review of visit audiotapes, of primary care practice with chronic-disease patients. METHODS. We analyzed 439 interactions between adult patients with chronic disease and 49 physicians. We explored the content, frequency, intensity, and dynamics of health promotion discussion during these routine visits. RESULTS. There was evidence of health promotion discussion in more than half (53%) of the audiotapes reviewed. When life-style topics were discussed, the discussion lasted a mean of 4 1/2 minutes, or 20% of the length of the visit. Diet/weight control was the most frequently discussed topic, followed by exercise, stress, smoking, and alcohol. Stress was by far the most time-consuming topic; stress-related discussion took an average of 6 minutes. CONCLUSIONS. Nearly 60% of the discussion that took place were not merely perfunctory but were attempts to counsel or encourage behavior change in the patient. Physicians used a wide range of behavioral counseling strategies, including providing a rationale for the recommended change and specific instructions to facilitate change. Other strategies noted as "effective" in the literature, however, were used infrequently and indicate obvious areas of weakness in physician performance.

Primary Care: Is There Enough Time for Prevention?

“…In another study, audiotapes of patient visits for chronic diseases showed that 53% of the visits included prevention activities that required about 4.5 minutes per encounter. 40 Rafferty studied service delivery in primary care clinics for indigent patients and found that clinicians spent 11% of their time on prevention (about 7 minutes per patient per year). Half of this time was spent screening for breast and cervical cancer.…”

Commentary on Nilsen et al. (2011): The importance of asking patients—the potential value of patient report of brief interventions

“…Surveys in other countries over the past two decades have had similarly disappointing results with only a minority of patients reporting having been advised or even asked about alcohol use (Table S1; see supporting information details at the end). Further, alcohol-related discussions that do occur last a few minutes or less [5][6][7].…”

Communication about behavioral health risks

“…Physicians are in a good position to provide screening and counseling, as most adults visit a physician at least once per year 5 . However, screening and counseling rates are low, 6,7 and commonly used counseling strategies may be inadequate to effect behavioral change 8,9 …”